Provider Demographics
NPI:1205933215
Name:PARK LENOX PSYCHIATRY
Entity type:Organization
Organization Name:PARK LENOX PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR OF PSYCHIATRY
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:POAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-434-2810
Mailing Address - Street 1:130 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1851
Mailing Address - Country:US
Mailing Address - Phone:212-434-2830
Mailing Address - Fax:212-434-2830
Practice Address - Street 1:130 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1851
Practice Address - Country:US
Practice Address - Phone:212-434-2830
Practice Address - Fax:212-434-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV80521Medicare UPIN
NY183BN1Medicare PIN
NY007BD2Medicare PIN
NY71M441Medicare PIN
NY2E2251Medicare PIN
NYW15551Medicare PIN
NY8U6852Medicare PIN