Organization
PARK AVENUE FACIAL SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOELLEN GATELY (ACCOUNT MANAGER)
(631) 732-7426
Entity
Organization
Contact information
Practice address
1040 PARK AVE, 86TH STREET, NEW YORK, NY 10028-1032
(212) 452-3362
Mailing address
1040 PARK AVE, 86TH STREET, NEW YORK, NY 10028-1032
(212) 452-3362
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/28/2007
Last updated
07/20/2011
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