# 969 PARK SURGICAL SUITE PLLC

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

## Provider details

- **NPI number:** 1851251896
- **Authorized official:** AVIVA PREMINGER MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (212) 706-1900

## Contact information

- **Practice address:** 969 PARK AVE STE 1F, NEW YORK, NY 10028-0322
- **Practice address phone:** (917) 382-4544
- **Mailing address:** 969 PARK AVE STE 1F, NEW YORK, NY 10028-0322
- **Mailing address phone:** (999) 999-9999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208200000X | Plastic Surgery Physician | — | — | Yes |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/13/2025
- **Last updated:** 03/18/2026