Provider Demographics
NPI:1902028046
Name:PARK AVENUE DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PARK AVENUE DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:I
Authorized Official - Last Name:KAMDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-594-7171
Mailing Address - Street 1:45 E 33RD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5336
Mailing Address - Country:US
Mailing Address - Phone:212-594-7171
Mailing Address - Fax:212-447-0896
Practice Address - Street 1:45 E 33RD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5336
Practice Address - Country:US
Practice Address - Phone:212-594-7171
Practice Address - Fax:212-447-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317391223G0001X
NY0494311223G0001X
NY0342071223P0300X
NY0467941223S0112X
NY0200851124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty