Provider Demographics
NPI:1083496038
Name:AVATAR WELLNESS LLC
Entity Type:Organization
Organization Name:AVATAR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:716-425-1499
Mailing Address - Street 1:250 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4927
Mailing Address - Country:US
Mailing Address - Phone:716-425-1499
Mailing Address - Fax:
Practice Address - Street 1:250 PINE ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4927
Practice Address - Country:US
Practice Address - Phone:716-425-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty