Provider Demographics
NPI:1457638843
Name:LOUIS DALAVERIS, M.D., P.C.
Entity Type:Organization
Organization Name:LOUIS DALAVERIS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAVERIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-245-0203
Mailing Address - Street 1:30 W 60TH ST
Mailing Address - Street 2:SUITE 1Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7902
Mailing Address - Country:US
Mailing Address - Phone:212-245-0203
Mailing Address - Fax:212-245-0372
Practice Address - Street 1:30 W 60TH ST
Practice Address - Street 2:SUITE 1Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7902
Practice Address - Country:US
Practice Address - Phone:212-245-0203
Practice Address - Fax:212-245-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY145813207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00758030Medicaid
B19873Medicare UPIN
NY90A861Medicare PIN
NY00758030Medicaid