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General NPI Number Information
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NPI Number | 1578825550
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Entity Type | Organization
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Legal Business Name | SPORTOPEDIA
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 4 HAALON ST
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City | RAMAT HASHARON
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State | ISRAEL
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Zip | 47282
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Country | IL
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Telephone | 97235400802
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Fax |
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Provider Business Mailing Address
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Address Line | 4 HAALON ST
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City | RAMAT HASHARON
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State | ISRAEL
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Zip | 47282
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Country | IL
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Telephone | 97235400802
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Fax |
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Authorized Official
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Title or Position | AFFILIATE
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Name | DR. HADAS AVNI
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Credential | MD
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Telephone | 97235400802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 26700
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License Number State | ZZ
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