Organization
PARK AMBULATORY SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STAFFORD R BROUMAND M.D. (PRESIDENT)
(718) 672-2824
Entity
Organization
Contact information
Practice address
740 PARK AVE, NEW YORK, NY 10021-4251
(718) 672-2824
(718) 672-4251
Mailing address
740 PARK AVE, NEW YORK, NY 10021-4251
(718) 672-2824
(718) 672-4251
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A3173382
OXFORD
NY
Enumeration date
05/22/2007
Last updated
08/22/2020
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