Provider Demographics
NPI:1972611614
Name:REGGEV, AVNER (MD)
Entity Type:Individual
Prefix:DR
First Name:AVNER
Middle Name:
Last Name:REGGEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WODDLAND PLACE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-472-6365
Mailing Address - Fax:
Practice Address - Street 1:280 N. CETRAL AVE, #310A
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-285-1721
Practice Address - Fax:914-285-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131178207R00000X
MEMD27723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY131178OtherSTATE MEDICAL LICENSE
NP363OtherOXFORD HEALTH PLANS
0C411POtherHIP MED INS
NY0060721OtherGHI MEDICAL INS
NY343171OtherEMPIRE BLUE CROSS AND BLU
NY00248513Medicaid
NY343172OtherEMPIRE BLUE CROSS AND BLU
NY343173OtherEMPIRE BLUE CROSS AND BLU
NY343173OtherEMPIRE BLUE CROSS AND BLU
NY343172OtherEMPIRE BLUE CROSS AND BLU
NP363OtherOXFORD HEALTH PLANS
NY343172Medicare ID - Type Unspecified
0C411POtherHIP MED INS
NY343171OtherEMPIRE BLUE CROSS AND BLU
NY343171Medicare ID - Type Unspecified
343171Medicare PIN
343173Medicare PIN