Park Avenue Medical Office, PLLC

Primary specialty

Allergy & Immunology (Internal Medicine) PhysicianTaxonomy code 207RA0201X

Legal business name

PARK AVENUE MEDICAL OFFICE, PLLC

Practice address

642 Park Ave
New York, NY 10065-6105

Phone

(212) 517-6611

Fax

(212) 517-2132

NPI assigned

Sep 26, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wellington S Tichenor, MDNPI 1508871450

Title

Owner

Phone

(212) 517-6611

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wellington Shelton Tichenor, M.D.

  • Allergy Physician
  • New York, NY
  • NPI 1508871450
  NPD (past) Authorized official
• Mary Youch, F.N.P

  • Family Nurse Practitioner
  • New York, NY
  • NPI 1821413246
  NPD (past)
• Katherine Eleanor Roarty, APRN

  • Adult Health Nurse Practitioner
  • Derby, CT
  • NPI 1407177496
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569456000000",
    "number": "1013568435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656105",
            "telephone_number": "212-517-6611",
            "fax_number": "212-517-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656105",
            "telephone_number": "212-517-6611",
            "fax_number": "212-517-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE MEDICAL OFFICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A",
        "authorized_official_last_name": "TICHENOR",
        "authorized_official_first_name": "WELLINGTON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-517-6611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0201X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wstichenor@sinuses.com",
            "affiliation": "N",
            "endpointDescription": "642 Park Avenue, New York NY 10065",
            "address_1": "642 Park Ave",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100656105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Park Avenue Medical Care PC
• Park Avenue Medical Equipment LLC
• Park Avenue Medical Group, P.C.
• Park Avenue Medical Imaging and Mommography
• Park Avenue Medical Imaging PC
• Park Avenue Medical PLLC
• Park Avenue Medical Professionals
• Park Avenue Medical Suite
• Park Avenue Medical Weight and Wellness P.C.
• Park Avenue Medicl Associates P.L.L.C

• Allergy & Immunology (Internal Medicine) Physician in New York, NY
• Providers in New York, NY by specialty
• Allergy & Immunology (Internal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.