Healthcare Provider Details

I. General information

NPI: 1578825550
Provider Name (Legal Business Name): SPORTOPEDIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HAALON ST
RAMAT HASHARON ISRAEL
47282
IL

IV. Provider business mailing address

4 HAALON ST
RAMAT HASHARON ISRAEL
47282
IL

V. Phone/Fax

Practice location:
  • Phone: 97235400802
  • Fax:
Mailing address:
  • Phone: 97235400802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number26700
License Number StateZZ

VIII. Authorized Official

Name: DR. HADAS AVNI
Title or Position: AFFILIATE
Credential: MD
Phone: 97235400802