Provider Demographics
NPI:1235524174
Name:AVELLINA, INC
Entity Type:Organization
Organization Name:AVELLINA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDICHEVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-676-9333
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-6628
Mailing Address - Country:US
Mailing Address - Phone:215-830-9991
Mailing Address - Fax:
Practice Address - Street 1:9867 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2611
Practice Address - Country:US
Practice Address - Phone:215-676-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty