Organization
PARK AVENUE MAXILLARY & MANDIBULAR RESTORATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA PONCE (OFFICE SUPERVISOR)
(212) 838-0090
Entity
Organization
Contact information
Practice address
563 PARK AVE, NEW YORK, NY 10065-7379
(212) 838-0090
(212) 935-1296
Mailing address
563 PARK AVE, NEW YORK, NY 10065-7379
(212) 838-0090
(212) 935-1296
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0386071
NY
Other
Enumeration date
01/25/2011
Last updated
01/25/2011
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