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PARK AVENUE MEDICAL OFFICE, PLLC
NPI 1013568435
Internal Medicine - Allergy & Immunology in New York, NY

Active since September 26, 2019CLIA 33D2178880 · Microscopy
642 PARK AVE, NEW YORK, NY 10065(212) 517-6611(212) 517-2132 Get Directions Write a Review

NPPES record last updated: September 26, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Park Avenue Medical Office, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK AVENUE MEDICAL OFFICE, PLLC (NPI 1013568435) is a healthcare organization registered as an allergy & immunology in New York, New York and active in the NPI registry since September 2019. The organization holds a CLIA Microscopy certificate valid through February 10, 2028 and lists Wellington S Tichenor, Owner, as its authorized official.

NPPES Registry Identity

NPI1013568435
Entity TypeOrganization
Primary Taxonomy207RA0201X
Legal Business NamePARK AVENUE MEDICAL OFFICE, PLLC
Location Address642 PARK AVENew York, NY 10065-6105
Mailing Address642 Park AveNew York, NY 10065-6105 · (212) 517-6611 · Fax (212) 517-2132
Phone(212) 517-6611
Fax(212) 517-2132
Organization SubpartNo
Authorized OfficialWellington S TichenorOwner · (212) 517-6611
Enumeration DateSeptember 26, 2019
✔ NPI 1013568435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Allergy & ImmunologyAllopathic & Osteopathic Physicians
Taxonomy Code207RA0201X
Definition
An internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Special Qualifications in the field of Allergy & Immunology.
642 PARK AVE, New York, NY 10065
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 33D2178880

Park Avenue Medical Office PLLC · New York, NY
Active · expires Feb 10, 2028
CLIA Number33D2178880
Laboratory TypePhysician Office
Certificate Effective DateFebruary 11, 2026
Certificate Expiration DateFebruary 10, 2028
Laboratory DirectorDr. Wellington Tichenor
Laboratory Phone(212) 517-6611
Laboratory LocationPark Avenue Medical Office PLLC1535 Second Avenue, New York, NY 10075
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARY YOUCH F.N.P
Nurse Practitioner (Family)
642 PARK AVE
NEW YORK, NY 10065
New York County (212) 517-6611

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Park Avenue Medical Office, PLLC's NPI number?

The NPI number for Park Avenue Medical Office, PLLC is 1013568435. It was assigned to this organization in the NPPES registry on September 26, 2019.

Where is Park Avenue Medical Office, PLLC located?

Park Avenue Medical Office, PLLC is located at 642 Park Ave, New York, NY 10065. The listed phone number is (212) 517-6611.

What is Park Avenue Medical Office, PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Allergy & Immunology, with taxonomy code 207RA0201X.

Does Park Avenue Medical Office, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 33D2178880) is associated with this NPI, valid through February 10, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Park Avenue Medical Office, PLLC was last updated on September 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.