Provider Demographics
NPI:1679968499
Name:PARK AVE RECONSTRUCTIVE LLC
Entity type:Organization
Organization Name:PARK AVE RECONSTRUCTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SENDEROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-481-3939
Mailing Address - Street 1:461 PARK AVE SOUTH STE 7A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8403
Mailing Address - Country:US
Mailing Address - Phone:212-481-3939
Mailing Address - Fax:212-688-6602
Practice Address - Street 1:461 PARK AVE SOUTH STE 7A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8403
Practice Address - Country:US
Practice Address - Phone:212-481-3939
Practice Address - Fax:212-688-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical