Provider Demographics
NPI:1861645541
Name:PARK AVENUE ANESTHESIOLOGY, PLLC
Entity Type:Organization
Organization Name:PARK AVENUE ANESTHESIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-583-2900
Mailing Address - Street 1:110 E 59TH ST
Mailing Address - Street 2:10D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1304
Mailing Address - Country:US
Mailing Address - Phone:212-583-2900
Mailing Address - Fax:212-644-2552
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:10D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-583-2900
Practice Address - Fax:212-644-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191870261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy