Provider Demographics
NPI:1053480624
Name:AVELLINO, RALPH V (OTR)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:V
Last Name:AVELLINO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRIDAL PATH
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2608
Mailing Address - Country:US
Mailing Address - Phone:631-758-2853
Mailing Address - Fax:
Practice Address - Street 1:159 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2205
Practice Address - Country:US
Practice Address - Phone:631-543-4500
Practice Address - Fax:631-543-5162
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist