Provider Demographics
NPI:1508312372
Name:LAVINE, MICHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:
Last Name:LAVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RIVERSIDE BLVD APT 16B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0315
Mailing Address - Country:US
Mailing Address - Phone:212-794-1742
Mailing Address - Fax:
Practice Address - Street 1:80 RIVERSIDE BLVD APT 16B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-0315
Practice Address - Country:US
Practice Address - Phone:212-794-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141696-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist