Provider Demographics
NPI:1689683807
Name:AVAG MEDICAL PC
Entity Type:Organization
Organization Name:AVAG MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:Z
Authorized Official - Last Name:AVAGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-348-3620
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-0243
Mailing Address - Country:US
Mailing Address - Phone:212-426-9222
Mailing Address - Fax:212-426-1409
Practice Address - Street 1:2124 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3306
Practice Address - Country:US
Practice Address - Phone:212-426-9222
Practice Address - Fax:212-426-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW89162Medicare ID - Type Unspecified
NYH19985Medicare UPIN