Provider Demographics
NPI:1841739331
Name:AVIGDOR MEDICAL HEALTH LLC
Entity Type:Organization
Organization Name:AVIGDOR MEDICAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIGDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-759-1730
Mailing Address - Street 1:47 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2311
Mailing Address - Country:US
Mailing Address - Phone:631-805-6384
Mailing Address - Fax:631-849-5824
Practice Address - Street 1:6 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1035
Practice Address - Country:US
Practice Address - Phone:631-805-6384
Practice Address - Fax:631-849-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03168200208600000X
NY130475208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty