Provider Demographics
NPI:1578825550
Name:SPORTOPEDIA
Entity Type:Organization
Organization Name:SPORTOPEDIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AFFILIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:HADAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AVNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9723-540-0802
Mailing Address - Street 1:4 HAALON ST
Mailing Address - Street 2:
Mailing Address - City:RAMAT HASHARON
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:47282
Mailing Address - Country:IL
Mailing Address - Phone:9723-540-0802
Mailing Address - Fax:
Practice Address - Street 1:4 HAALON ST
Practice Address - Street 2:
Practice Address - City:RAMAT HASHARON
Practice Address - State:ISRAEL
Practice Address - Zip Code:47282
Practice Address - Country:IL
Practice Address - Phone:9723-540-0802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ26700305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service