Provider Demographics
NPI:1316233448
Name:PARK AVENUE MAMMOGRAPHY
Entity type:Organization
Organization Name:PARK AVENUE MAMMOGRAPHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-615-9362
Mailing Address - Street 1:330 E 38TH ST
Mailing Address - Street 2:STE 44I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PARK AVE S
Practice Address - Street 2:STE 1103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1503
Practice Address - Country:US
Practice Address - Phone:212-661-0514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty