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NPI Code Detail

MEDICARE: MISS JENNIFER ANN AVILA

MEDICARE:  MISS JENNIFER ANN AVILA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistNY

General Provider Information

NPI Number : 1073874137
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JENNIFER ANN AVILA
Provider Business Mailing Address
First Line : 9711 133RD ST
Second Line :
City : SOUTH RICHMOND HILL
State : NY
Zip : 11419-2324
Country : US
Telephone Number : 917-386-3607
Fax Number :
Provider Business Practice Location Address
First Line : 9711 133RD ST
Second Line :
City : SOUTH RICHMOND HILL
State : NY
Zip : 11419-2324
Country : US
Telephone Number : 917-386-3607
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 06/06/2012

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Directions to “ MISS JENNIFER ANN AVILA ” Practice Location

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