# PARK AVENUE PERIODONTAL PROSTHESIS OBS FACILITY

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

## Provider details

- **NPI number:** 1285880427
- **Authorized official:** DR. PASQUALE J MALPESO D.M.D. (OWNER)
- **Authorized official phone:** (212) 838-0090

## Contact information

- **Practice address:** 563 PARK AVE, NEW YORK, NY 10065-7314
- **Practice address phone:** (212) 838-0090
- **Practice address fax:** (212) 935-1296
- **Mailing address:** 563 PARK AVE, NEW YORK, NY 10065-7314
- **Mailing address phone:** (212) 838-0090
- **Mailing address fax:** (212) 935-1296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 08/07/2008
- **Last updated:** 08/07/2008