Healthcare Provider Details

I. General information

NPI: 1386602084
Provider Name (Legal Business Name): DR. NEFTALI Z AVIGDOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 KNICKERBOCKER AVE
BROOKLYN NY
11237-3601
US

IV. Provider business mailing address

10230 66TH RD APT 7B
FOREST HILLS NY
11375-7617
US

V. Phone/Fax

Practice location:
  • Phone: 718-381-5600
  • Fax: 718-456-1068
Mailing address:
  • Phone: 718-381-5600
  • Fax: 718-456-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number158911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: