OrganizationActive
Park Avenue Medical Office, PLLC
NPI 1013568435 · Allergy & Immunology (Internal Medicine) Physician · New York, NY
Provider details
- NPI number
- 1013568435
- Entity type
- Organization
- Primary specialty
- Allergy & Immunology (Internal Medicine) PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Wellington Tichenor, Owner
Practice location
642 Park Ave
New York, NY 10065-6105
Phone: (212) 517-6611
Fax: (212) 517-2132
Mailing address
642 Park Ave
New York, NY 10065-6105
Registry dates
- Enumerated
- 2019-09-26
- Last updated
- 2019-09-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.