Organization
PARK 62 ORAL FACIAL SURGERY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY CHOTKOWSKI D.M.D. (MEDICAL DIRECTOR)
(212) 838-0090
Entity
Organization
Contact information
Practice address
563 PARK AVE, NEW YORK, NY 10065-7379
(212) 838-0090
Mailing address
563 PARK AVE., NEW YORK, NY 10065
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
440777
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
440777
THE JOINT COMMISSION
NY
Enumeration date
05/08/2017
Last updated
05/08/2017
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