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General NPI Number Information
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NPI Number | 1285805507
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Entity Type | Organization
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Legal Business Name | AVELLINA INC.
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 2375 WOODWARD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19115-5120
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Country | US
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Telephone | 215-676-9223
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1628
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City | HORSHAM
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State | PA
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Zip | 19044-6628
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Country | US
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Telephone | 215-830-9991
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIOLETTA BERDICHEVSKAYA
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Credential | M.D.
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Telephone | 215-938-1353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | PA
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