Provider Demographics
NPI:1013792191
Name:MEYERS, AVIGAIL TAMAR
Entity Type:Individual
Prefix:
First Name:AVIGAIL
Middle Name:TAMAR
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8519 124TH ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3308
Mailing Address - Country:US
Mailing Address - Phone:929-444-6019
Mailing Address - Fax:
Practice Address - Street 1:8519 124TH ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3308
Practice Address - Country:US
Practice Address - Phone:929-444-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator