Provider Demographics
NPI:1104992072
Name:PARKMED, LLC
Entity type:Organization
Organization Name:PARKMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MABERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-686-6402
Mailing Address - Street 1:800 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4709
Mailing Address - Country:US
Mailing Address - Phone:212-686-6402
Mailing Address - Fax:212-779-7724
Practice Address - Street 1:800 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4709
Practice Address - Country:US
Practice Address - Phone:212-686-6402
Practice Address - Fax:212-779-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QA1903X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995519Medicaid