Provider Demographics
NPI:1184013070
Name:AVERION, ORIEL
Entity Type:Individual
Prefix:
First Name:ORIEL
Middle Name:
Last Name:AVERION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GRAND ST STE 15
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4240
Mailing Address - Country:US
Mailing Address - Phone:201-333-6990
Mailing Address - Fax:201-333-6512
Practice Address - Street 1:414 GRAND ST STE 15
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4240
Practice Address - Country:US
Practice Address - Phone:201-333-6990
Practice Address - Fax:201-333-6512
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03678300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist