# PARK 62 ORAL FACIAL SURGERY P.C.

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

## Provider details

- **NPI number:** 1518493717
- **Authorized official:** GREGORY CHOTKOWSKI D.M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (212) 838-0090

## Contact information

- **Practice address:** 563 PARK AVE, NEW YORK, NY 10065-7379
- **Practice address phone:** (212) 838-0090
- **Mailing address:** 563 PARK AVE., NEW YORK, NY 10065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 440777 | NY | Yes |

## Other

- **Enumeration date:** 05/08/2017
- **Last updated:** 05/08/2017