Provider Demographics
NPI:1588706204
Name:PARK AVENUE PODIATRY, LLC
Entity type:Organization
Organization Name:PARK AVENUE PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CHAN
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-966-8818
Mailing Address - Street 1:102 PARK AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2934
Mailing Address - Country:US
Mailing Address - Phone:914-966-8818
Mailing Address - Fax:914-966-8814
Practice Address - Street 1:102 PARK AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2934
Practice Address - Country:US
Practice Address - Phone:914-966-8818
Practice Address - Fax:914-966-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty