AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC — NPI 1417155565 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in NEW YORK, NY)

CMS-1500 Box 24J / 33a • NPI

1417155565

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QA1903X (CMS 49)

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

655 PARK AVE, SUITE NETC, NEW YORK, NY, 10065-5937

✓ 9-Digit EDI 837 ZIP+4 (10065-5937)

Practice Phone & Referral Fax

(212) 794-3900

Fax: (212) 794-0760

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417155565 (AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417155565` (NPI-2 Organization / Facility)
Provider / Legal Name	AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QA1903X` (Clinic/Center, Ambulatory Surgical)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	655 PARK AVE, SUITE NETC, NEW YORK, NY, 10065-5937
Practice Telephone / Fax	Tel: (212) 794-3900 \| Fax: (212) 794-0760
Administrative Mailing Address	200 LA BONNE VIE DR, EAST PATCHOGUE, NY, 11772-4434
Enumeration & Last Sync	Enumerated: 2007-07-10 \| CMS Record Updated: 2007-07-10
Authorized Official	SCOTT WELLS (Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

655 PARK AVE, SUITE NETC, NEW YORK, NY, 10065-5937

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Plain-English Taxonomy & CMS Crosswalk (261QA1903X)

What Does Taxonomy Code 261QA1903X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QA1903X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 49 (Ambulatory Surgical Center)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QA1903X` — Clinic/Center, Ambulatory Surgical Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC (NPI #1417155565)