Provider Demographics
NPI:1184782492
Name:AVELLA, JANE (MD)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:AVELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:AVELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:292 HERRICKS RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1119
Mailing Address - Country:US
Mailing Address - Phone:516-746-2273
Mailing Address - Fax:516-746-2272
Practice Address - Street 1:292 HERRICKS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1119
Practice Address - Country:US
Practice Address - Phone:516-294-8910
Practice Address - Fax:516-294-4009
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140720207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY35E85EE3G1Medicare PIN