Provider Demographics
NPI:1245821610
Name:TONY AND AVA LLC
Entity type:Organization
Organization Name:TONY AND AVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:IACOVIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-223-2950
Mailing Address - Street 1:452 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1244
Mailing Address - Country:US
Mailing Address - Phone:197-322-3295
Mailing Address - Fax:
Practice Address - Street 1:452 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1244
Practice Address - Country:US
Practice Address - Phone:197-322-3295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies