Healthcare Provider Details

I. General information

NPI: 1548401573
Provider Name (Legal Business Name): ELI NARCISO AVILA MD, JD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2009
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BUFFINGTON ST BLDG 40-4
WATERVLIET NY
12189-4050
US

IV. Provider business mailing address

1 BUFFINGTON ST BLDG 40-4
WATERVLIET NY
12189-4050
US

V. Phone/Fax

Practice location:
  • Phone: 518-266-4195
  • Fax: 518-266-4547
Mailing address:
  • Phone: 518-266-4195
  • Fax: 518-266-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number171294
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number171294
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: