Provider Demographics
NPI:1528261385
Name:PARK AVENUE MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PARK AVENUE MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-438-5900
Mailing Address - Street 1:30 PARK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1000
Mailing Address - Country:US
Mailing Address - Phone:201-438-5900
Mailing Address - Fax:
Practice Address - Street 1:30 PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1000
Practice Address - Country:US
Practice Address - Phone:201-438-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04207400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026678Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDERID
NJE53706Medicare UPIN
NJ586535M81Medicare ID - Type UnspecifiedDR. JANE HOSKIN
NJ608916M81Medicare ID - Type UnspecifiedDR. RHONDA HAGLER
NJF80137Medicare UPIN
NJE52470Medicare UPIN
NJ766025M81Medicare ID - Type UnspecifiedDR. SOHEILA VOSSOUGH