Provider Demographics
NPI:1912315771
Name:DR AVIA REUVENI DPM PA
Entity Type:Organization
Organization Name:DR AVIA REUVENI DPM PA
Other - Org Name:PINE STREET PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REUVENI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-503-7676
Mailing Address - Street 1:407 ALAMANDA DR
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6507
Mailing Address - Country:US
Mailing Address - Phone:954-399-0328
Mailing Address - Fax:561-300-8617
Practice Address - Street 1:127 PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1240
Practice Address - Country:US
Practice Address - Phone:717-503-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty