Provider Demographics
NPI:1205937968
Name:PARK AVENUE SURGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PARK AVENUE SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-369-2222
Mailing Address - Street 1:1175 PARK AVE
Mailing Address - Street 2:SUITE 1 C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1211
Mailing Address - Country:US
Mailing Address - Phone:212-369-2222
Mailing Address - Fax:212-348-1392
Practice Address - Street 1:1175 PARK AVE
Practice Address - Street 2:SUITE 1 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1211
Practice Address - Country:US
Practice Address - Phone:212-369-2222
Practice Address - Fax:212-348-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWQ091Medicare PIN