Provider Demographics
NPI:1770502965
Name:AVELLA, HAROLD (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:AVELLA
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 1:8 DIPLOMAT DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2292
Mailing Address - Country:US
Mailing Address - Phone:631-846-4044
Mailing Address - Fax:631-846-4044
Practice Address - Street 1:752 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3900
Practice Address - Country:US
Practice Address - Phone:631-385-0207
Practice Address - Fax:631-385-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197663208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG05640Medicare UPIN
NY200361Medicare ID - Type Unspecified