Provider Demographics
NPI:1326336504
Name:AVALLONE, JOAN (ORTL)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:AVALLONE
Suffix:
Gender:F
Credentials:ORTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BRANFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706
Mailing Address - Country:US
Mailing Address - Phone:914-815-2995
Mailing Address - Fax:
Practice Address - Street 1:39 WEST 14TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:914-815-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002533-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist