Organization
PARK AVENUE MEDICAL OFFICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WELLINGTON S TICHENOR MD (OWNER)
(212) 517-6611
Entity
Organization
Contact information
Practice address
642 PARK AVE, NEW YORK, NY 10065-6105
(212) 517-6611
(212) 517-2132
Mailing address
642 PARK AVE, NEW YORK, NY 10065-6105
(212) 517-6611
(212) 517-2132
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
09/26/2019
Last updated
09/26/2019
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