Provider Demographics
NPI:1124725312
Name:737 PARK AVENUE SURGICAL SUITES, LLC
Entity type:Organization
Organization Name:737 PARK AVENUE SURGICAL SUITES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-794-5096
Mailing Address - Street 1:737 PARK AVE FRNT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4248
Mailing Address - Country:US
Mailing Address - Phone:212-794-5096
Mailing Address - Fax:917-591-1312
Practice Address - Street 1:737 PARK AVE FRNT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4248
Practice Address - Country:US
Practice Address - Phone:212-794-5096
Practice Address - Fax:917-591-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical