Healthcare Provider Details

I. General information

NPI: 1477938033
Provider Name (Legal Business Name): AVISHAI NEUMAN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 WILSON ST
VALLEY STREAM NY
11581-3527
US

IV. Provider business mailing address

811 WILSON ST
VALLEY STREAM NY
11581-3527
US

V. Phone/Fax

Practice location:
  • Phone: 718-550-8600
  • Fax:
Mailing address:
  • Phone: 718-550-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number245594
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number229793
License Number StateNY

VIII. Authorized Official

Name: AVISHAI T NEUMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-550-8600