Provider Demographics
NPI:1801800263
Name:AVILES SANCHEZ, ISRAEL ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:ANGEL
Last Name:AVILES SANCHEZ
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 1:1204 HARMON COVE TOWER
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-1714
Mailing Address - Country:US
Mailing Address - Phone:718-396-2005
Mailing Address - Fax:
Practice Address - Street 1:9001A ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7938
Practice Address - Country:US
Practice Address - Phone:718-396-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE40698Medicare UPIN