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General NPI Number Information
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NPI Number | 1194952986
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Entity Type | Organization
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Legal Business Name | SAMUEL BAVLI, MD
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 327 BEACH 19TH ST DEPARTMENT OF MEDICINE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4423
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Country | US
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Telephone | 718-869-7315
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Fax |
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Provider Business Mailing Address
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Address Line | 327 BEACH 19TH ST DEPARTMENT OF MEDICINE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4423
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMUEL BAVLI
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Credential | MD
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Telephone | 718-869-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 109310-1
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License Number State | NY
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