NPIMap

Organization Active NPI

Park Avenue Endoscopy, PLLC

  • Endoscopy Clinic/Center
  • New York, NY
National Provider Identifier
1669595385
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endoscopy Clinic/CenterTaxonomy code 261QE0800X
Legal business name
PARK AVENUE ENDOSCOPY, PLLC
Practice address
642 Park Avenue
New York, NY 10021-6105
Phone
(212) 517-6611
Fax
(212) 517-2132
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

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

Authorized official

Name
Dr. Wellington Shelton Tichenor, M.D.NPI 1508871450
Title
Owner
Phone
(212) 517-6611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endoscopy Clinic/Center 261QE0800X NY Primary

Addresses

Primary practice location

642 Park Avenue
New York, NY 10021-6105

Mailing address

642 Park Ave
New York, NY 10065-6105
Phone (212) 517-6611

Other names 1

  • Wellington S. Tichenor, M.D. Other name

National Provider Directory

National Provider Directory

Locations

642 Park Ave
New York, NY 10065
Phone (212) 517-6611

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1669595385",
    "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 AVENUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100216105",
            "telephone_number": "212-517-6611",
            "fax_number": "212-517-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE ENDOSCOPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "TICHENOR",
        "authorized_official_first_name": "WELLINGTON",
        "authorized_official_middle_name": "SHELTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-517-6611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellington S. Tichenor, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; 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.