Provider Demographics
NPI:1164552279
Name:AVROM GART MD INC
Entity Type:Organization
Organization Name:AVROM GART MD INC
Other - Org Name:GART BERKLEY SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVROM
Authorized Official - Middle Name:
Authorized Official - Last Name:GART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-423-9900
Mailing Address - Street 1:122 SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3915
Mailing Address - Country:US
Mailing Address - Phone:310-322-4278
Mailing Address - Fax:310-322-6660
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:SUITE #800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9900
Practice Address - Fax:310-423-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG593722081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN
CAW21458Medicare PIN