Provider Demographics
NPI:1326250648
Name:AVILA, P.GIORDANA (OD)
Entity Type:Individual
Prefix:
First Name:P.GIORDANA
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 73RD ST
Mailing Address - Street 2:#8E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9400
Mailing Address - Country:US
Mailing Address - Phone:212-472-5869
Mailing Address - Fax:212-758-4175
Practice Address - Street 1:160 E 56TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3609
Practice Address - Country:US
Practice Address - Phone:212-758-3838
Practice Address - Fax:212-758-4175
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068165Medicare ID - Type Unspecified