Provider Demographics
NPI:1063624260
Name:PARK AVENUE PULMONARY CARE PLLC
Entity type:Organization
Organization Name:PARK AVENUE PULMONARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEPALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-289-3627
Mailing Address - Street 1:1130 PARK AVENUE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-289-3627
Mailing Address - Fax:
Practice Address - Street 1:1130 PARK AVENUE
Practice Address - Street 2:SUITE #3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-289-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155703207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C34732Medicare UPIN
NYWPA111Medicare PIN