Provider Demographics
NPI:1881873842
Name:PARK AVENUE TOTAL MEDICAL CARE
Entity type:Organization
Organization Name:PARK AVENUE TOTAL MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-427-2000
Mailing Address - Street 1:120 E 86TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1062
Mailing Address - Country:US
Mailing Address - Phone:212-427-2000
Mailing Address - Fax:212-427-2008
Practice Address - Street 1:120 E 86TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1062
Practice Address - Country:US
Practice Address - Phone:212-427-2000
Practice Address - Fax:212-427-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145091207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEC481Medicare PIN