Provider Demographics
NPI:1184662876
Name:AVRAMOV, VIOLETA
Entity type:Individual
Prefix:
First Name:VIOLETA
Middle Name:
Last Name:AVRAMOV
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 1:633 RTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8007
Mailing Address - Country:US
Mailing Address - Phone:732-240-4787
Mailing Address - Fax:732-240-3114
Practice Address - Street 1:633 RTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8007
Practice Address - Country:US
Practice Address - Phone:732-240-4787
Practice Address - Fax:732-240-3114
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360943292084N0400X
NJ25MA101636002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094329Medicaid
L72642Medicare ID - Type Unspecified
IL036094329Medicaid