MEDICARE: AVIV HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1770249989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIV HEALTH PLLC

Provider Business Mailing Address
First Line	:	28 FLANNERY AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4750
Country	:	US
Telephone Number	:	732-267-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 FLANNERY AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4750
Country	:	US
Telephone Number	:	732-267-8747
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED USER
Name	:	HANA SICHEL
Credential	:
Telephone Number	:	347-496-5589

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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