Healthcare Provider Details

I. General information

NPI: 1699620138
Provider Name (Legal Business Name): DANIEL AVITAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 SW 20TH AVE
GAINESVILLE FL
32607-4504
US

IV. Provider business mailing address

3527 SW 20TH AVE
GAINESVILLE FL
32607-4504
US

V. Phone/Fax

Practice location:
  • Phone: 201-637-3236
  • Fax:
Mailing address:
  • Phone: 201-637-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG320562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: