Provider Demographics
NPI:1831443183
Name:AVISHAY, MONA (PA)
Entity type:Individual
Prefix:MRS
First Name:MONA
Middle Name:
Last Name:AVISHAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3508
Mailing Address - Country:US
Mailing Address - Phone:516-822-7546
Mailing Address - Fax:
Practice Address - Street 1:358 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3508
Practice Address - Country:US
Practice Address - Phone:516-822-7546
Practice Address - Fax:516-937-7546
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant