Provider Demographics
NPI:1871099697
Name:PARK AVENUE CLINIC, PC
Entity type:Organization
Organization Name:PARK AVENUE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-722-7130
Mailing Address - Street 1:107 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2328
Mailing Address - Country:US
Mailing Address - Phone:917-915-4227
Mailing Address - Fax:
Practice Address - Street 1:109 PARK AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2328
Practice Address - Country:US
Practice Address - Phone:973-380-0690
Practice Address - Fax:917-915-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07547100208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty