Provider Demographics
NPI:1396982807
Name:PARK AVENUE MANHATTAN MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:PARK AVENUE MANHATTAN MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-535-0229
Mailing Address - Street 1:885 PARK AVENUE
Mailing Address - Street 2:ENTRANCE ON 78 STREET
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-535-0229
Mailing Address - Fax:212-734-3192
Practice Address - Street 1:885 PARK AVE
Practice Address - Street 2:ENTRANCE ON 78 STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0383
Practice Address - Country:US
Practice Address - Phone:212-535-0229
Practice Address - Fax:212-734-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112817-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical