Provider Demographics
NPI:1558624007
Name:AVILA, JAVIER (MS ED)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 8TH AVENUE 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4306
Mailing Address - Country:US
Mailing Address - Phone:212-787-9700
Mailing Address - Fax:
Practice Address - Street 1:538 8TH AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4306
Practice Address - Country:US
Practice Address - Phone:212-787-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist