Doctor Name: | DR. JAMES RAYMOND AVELLINI |
NPI Number: | 1932352465 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 148049 |
Business Practice Address: | 10408 Roosevelt Ave Ll Corona, NY - 113682328 |
Business Phone Number: | 7184266500 |
Business Fax Number: | 7184266501 |
Mailing Address: | 10408 Roosevelt Ave, Ll CORONA |
State: | NY |
Postal Code: | 113682328 |
Phone Number: | 7184266500 |
Fax Number: | 7184266501 |
NPI Enumeration Date: | 10/28/2008 |
NPI Last Update Date: | 03/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 148049 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |