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General NPI Number Information
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NPI Number | 1619398542
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Entity Type | Organization
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Legal Business Name | AVICENNA ASC INC.
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 2522 HUGHES AVE
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City | BRONX
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State | NY
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Zip | 10458-5112
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Country | US
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Telephone | 718-933-1900
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Fax | 718-933-1938
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Provider Business Mailing Address
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Address Line | 2522 HUGHES AVE
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City | BRONX
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State | NY
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Zip | 10458-5112
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Country | US
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Telephone | 718-933-1900
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Fax | 718-933-1938
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MR. SHAHRIAR DANESHVAR
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Credential | CASC
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Telephone | 718-933-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | NY
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