Provider Demographics
NPI:1932213030
Name:AVITZUR, ORLY (MD)
Entity Type:Individual
Prefix:
First Name:ORLY
Middle Name:
Last Name:AVITZUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SOUTH BROADWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591
Mailing Address - Country:US
Mailing Address - Phone:914-631-0400
Mailing Address - Fax:914-631-0402
Practice Address - Street 1:55 SOUTH BROADWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-631-0400
Practice Address - Fax:914-631-0402
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1665302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64467Medicare UPIN
83D911Medicare ID - Type Unspecified