33D2197207 CLIA NUMBER - PARK AVENUE MEDICAL PROFESSIONALS PC

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Laboratory Demographics

CLIA Number: 33D2197207

Facility Name: PARK AVENUE MEDICAL PROFESSIONALS PC

Facility Address:
120 EAST 86TH STREET FL2
NEW YORK, NY
ZIP 10028
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Facility Phone Number: 212 427-3305

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396061891

Taxonomy: 1223S0112X - Dentist
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

CLIA Record

Field Name	Field Value
CLIA Number	33D2197207
LAB Type	Physician Office
Facility Name	PARK AVENUE MEDICAL PROFESSIONALS PC
Street	120 EAST 86TH STREET FL2
City	NEW YORK
State	NY
ZIP	10028
Phone	212 427-3305
CertificateType	4
CertificateEffectiveDate	10/22/2022
CertificateExpirationDate	10/21/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024