Provider Demographics
NPI:1508895657
Name:ADVANCE ORTHOPEDIC AND SPINE CARE, PLLC
Entity Type:Organization
Organization Name:ADVANCE ORTHOPEDIC AND SPINE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANESOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-891-7100
Mailing Address - Street 1:3059 BRIGHTON 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5607
Mailing Address - Country:US
Mailing Address - Phone:718-891-7100
Mailing Address - Fax:718-891-3834
Practice Address - Street 1:3059 BRIGHTON 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5607
Practice Address - Country:US
Practice Address - Phone:718-891-7100
Practice Address - Fax:718-891-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238138204D00000X, 207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty