Healthcare Provider Details

I. General information

NPI: 1265969836
Provider Name (Legal Business Name): DEENA AVNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MADISON AVE FL 2
MORRISTOWN NJ
07960-7337
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-4142
  • Fax: 973-290-7360
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA12169300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: