Provider Demographics
NPI:1760748677
Name:MASLAVI, ORLY (OD)
Entity Type:Individual
Prefix:
First Name:ORLY
Middle Name:
Last Name:MASLAVI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:KINGS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1218
Mailing Address - Country:US
Mailing Address - Phone:516-298-6667
Mailing Address - Fax:
Practice Address - Street 1:28 SHORE DR
Practice Address - Street 2:
Practice Address - City:KINGS POINT
Practice Address - State:NY
Practice Address - Zip Code:11024-1218
Practice Address - Country:US
Practice Address - Phone:516-298-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist