# PARK AVE AMBULATORY MEDICAL FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205094562
- **Authorized official:** DR. VADIM KUSHNERIK MD (SURGICAL DIRECTOR)
- **Authorized official phone:** (718) 422-5023

## Contact information

- **Practice address:** 360 COURT ST, SUITE\# 3, BROOKLYN, NY 11231-4353
- **Practice address phone:** (718) 422-5023
- **Practice address fax:** (718) 422-5025
- **Mailing address:** 360 COURT ST, SUITE\# 3, BROOKLYN, NY 11231-4353
- **Mailing address phone:** (718) 422-5023
- **Mailing address fax:** (718) 422-5025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 217486 | NY | Yes |

## Other

- **Enumeration date:** 05/22/2008
- **Last updated:** 05/22/2008