Healthcare Provider Details

I. General information

NPI: 1609851617
Provider Name (Legal Business Name): GAD AVSHALOMOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2084 E 67TH ST
BROOKLYN NY
11234-6008
US

IV. Provider business mailing address

4017 GREENTREE DR
OCEANSIDE NY
11572-5948
US

V. Phone/Fax

Practice location:
  • Phone: 718-444-8014
  • Fax: 718-444-8068
Mailing address:
  • Phone: 516-395-7198
  • Fax: 718-444-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number215924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: