Provider Demographics
NPI:1932475795
Name:AVITABILE, JUDITH THERESA (MS,PT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:THERESA
Last Name:AVITABILE
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 KEARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1318
Mailing Address - Country:US
Mailing Address - Phone:917-209-0586
Mailing Address - Fax:
Practice Address - Street 1:2750 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2210
Practice Address - Country:US
Practice Address - Phone:718-823-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6200865212251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics