Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Park Avenue Maxillary & Mandibular Restoration PC

Organization Ambulatory Surgical Clinic/Center · NPI 1457656381

Park Avenue Maxillary & Mandibular Restoration PC is an Ambulatory Surgical Clinic/Center 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
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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