Provider Demographics
NPI:1811206147
Name:LAVIAN, EMIL (DPM)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:
Last Name:LAVIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1428
Mailing Address - Country:US
Mailing Address - Phone:646-263-0080
Mailing Address - Fax:
Practice Address - Street 1:35 W 45TH ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4903
Practice Address - Country:US
Practice Address - Phone:646-535-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006389213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03339562Medicaid
NY03339562Medicaid