Provider Demographics
NPI:1740797299
Name:ISRAEL, AVI
Entity Type:Individual
Prefix:MR
First Name:AVI
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-0055
Mailing Address - Country:US
Mailing Address - Phone:716-984-8375
Mailing Address - Fax:716-259-9641
Practice Address - Street 1:737 DELAWARE AVE STE 216
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2260
Practice Address - Country:US
Practice Address - Phone:716-984-8375
Practice Address - Fax:716-259-9641
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)