Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Park Avenue Maxillary & Mandibular Restoration PC

Organization Ambulatory Surgical Clinic/Center · NPI 1457656381

Park Avenue Maxillary & Mandibular Restoration PC provides Ambulatory Surgical Clinic/Center services in New York, New York. Licensed in New York. Registered with an NPI since 2011.

Licensed in
NY
In the registry since
2011
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

563 Park Ave
New York, NY 10065-7379 Not confirmed with CMS for 15 years — call before visiting
Phone: (212) 838-0090
Fax: (212) 935-1296
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ambulatory Surgical Clinic/Center (primary) Taxonomy 261QA1903X · Licence 0386071 (NY)

Record details

NPI number1457656381
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Patricia Ponce — Office Supervisor · (212) 838-0090
NPI enumeratedJanuary 25, 2011
Last updated in NPPESJanuary 25, 2011
Mailing address563 Park Ave, New York, NY 10065-7379

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