Provider Demographics
NPI:1922754605
Name:CROTONA PARKWAY ASC, LLC
Entity Type:Organization
Organization Name:CROTONA PARKWAY ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALENTYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:203-917-0793
Mailing Address - Street 1:1976 CROTONA PKWY # 2A3B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-1526
Mailing Address - Country:US
Mailing Address - Phone:718-307-5700
Mailing Address - Fax:
Practice Address - Street 1:1976 CROTONA PKWY # 2A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1526
Practice Address - Country:US
Practice Address - Phone:203-917-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical