Provider Demographics
NPI:1235250242
Name:DRUKS, AVIVA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:
Last Name:DRUKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HILL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3757
Mailing Address - Country:US
Mailing Address - Phone:516-482-1846
Mailing Address - Fax:516-482-1846
Practice Address - Street 1:134 MIDDLE NECK RD
Practice Address - Street 2:SUITE 220
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1218
Practice Address - Country:US
Practice Address - Phone:516-482-1846
Practice Address - Fax:516-482-1846
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010578-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6803954Medicare UPIN
NY247193Medicare UPIN
NY3477075Medicare UPIN
NYP2139830Medicare UPIN