PARK AVENUE MEDICAL LLC (NPI# 1740546399) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740546399 |
| Entity Type | Organization |
| Organization Name | PARK AVENUE MEDICAL LLC |
| Practice Address |
85 Barnes Road Suite 202 Wallingford CT 06492 |
| Practice Telephone | 2033090070 |
| Practice Fax Number | 2033090071 |
| Mailing Telephone | (203) 309-0070 |
| Mailing Fax Number | 2033090071 |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2017-05-13 |
| Authorized Official Name | ANACE SAID (OWNER) |
| Authorized Official Telephone | 2033090070 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 044791 | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008002162 | 05 |
| Street Address |
85 BARNES ROAD SUITE 202 |
| City | WALLINGFORD |
| State | CT |
| Zip Code | 06492 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891310215 | The Promptcare Companies, Inc. | Durable Medical Equipment & Medical Supplies | 101 Noth Plains Industrial Park, Suite B Building 2 Harvest Park, Wallingford, CT 06492 | 2020-06-11 |
| 1528692480 | Hilary Caitlin Sullivan | Nurse Practitioner | Park Avenue Medical, LLC, 85 Barnes Road, Suite 202, Wallingford, CT 06492 | 2020-02-28 |
| 1902370943 | Alicia Anne Eldridge | Student in an Organized Health Care Education/Training Program | 88 Cheshire Road, Wallingford, CT 06492 | 2019-01-13 |
| 1114409562 | Doreen Gail Barile | Pharmacist | 846 North Colony Road, Wallingford, CT 06492 | 2018-09-02 |
| 1942782354 | Brad Becker | Pharmacist | 846 North Colony Rd, Walingford, CT 06492 | 2018-08-31 |
| 1477041564 | Melissa A Fazzolari | Nurse Practitioner | 850 N Main Street Ext Ste B, Wallingford, CT 06492 | 2018-04-25 |
| 1992235857 | Karen Ann Meers | Behavioral Analyst | 29 North Plains Highway, Unit 15, Wallingford, CT 06492 | 2017-06-14 |
| 1992232698 | Chelsea Clements | Occupational Therapist | 87 Southwind Dr, Wallingford, CT 06492 | 2017-05-12 |
| 1659822369 | Sara Frawley | Naturopath | 850 N. Main Street Extention, Building 2 Suite 3c, Wallingford, CT 06492 | 2016-10-18 |
| 1083085518 | Energetic Spine Chiropractic | Chiropractor | 1271 South Broad St., Unit #11, Wallingford, CT 06492 | 2015-10-09 |
| Find all providers in zip 06492 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417489253 | Yidi Ge | Internal Medicine | 850 N Main Street Ext Ste 1a3, Wallingford, CT 06492-2466 | 2017-03-31 |
| 1265853709 | Tamar V Jefferis | Internal Medicine | 19 N. Providence Road, Box 267, Wallingford, PA 19086 | 2013-12-31 |
| 1578824637 | Nkiruka Emeagwali | Internal Medicine | 44 N Plains Industrial Road, Wallingford, CT 06492 | 2012-06-06 |
| 1922308048 | Henry B. Hofbauer, Md, PC | Internal Medicine | 850 N Main Street Ext Ste 2c3, Wallingford, CT 06492-2469 | 2010-10-22 |
| 1396052460 | Sabina Sharmeen | Internal Medicine | 1161, Putnam Boulovard, Wallingford, PA 19086 | 2010-09-09 |
| 1326274960 | Yuliya Viktorovna Riat | Internal Medicine | 74 Cheshire Road, Wallingford, CT 06492-3095 | 2009-06-10 |
| 1760647176 | Sameer Syed | Internal Medicine | The Gaylord Hospital, 50 Gaylord Farm Road, Wallingford, CT 06492 | 2008-07-24 |
| 1316112279 | Bozena Krystyna Malyszko | Internal Medicine | 50 Gaylord Farm Rd, Wallingford, CT 06492-2828 | 2008-04-22 |
| 1760669691 | Carl Kellan | Internal Medicine | 26 Hillsview Ave, Wallingford, CT 06492-4632 | 2008-01-22 |
| 1336279561 | Maryanne Theresa Liberati-mitchell | Internal Medicine | 205 Fox Ln, Wallingford, PA 19086-6225 | 2007-03-06 |
| Find all providers in WALLINGFORD | ||||
| City | WALLINGFORD |
| Zip Code | 06492 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.