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NPI Code Detail

MEDICARE: DR. LORNA AVILA MD

MEDICARE: DR. LORNA AVILA MD
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
12084P0800XPsychiatry Physician179949NY

General Provider Information

NPI Number : 1346250545
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LORNA AVILA MD
Provider Business Mailing Address
First Line : 45 HUNTER AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2509
Country : US
Telephone Number : 718-273-9724
Fax Number : 718-983-0348
Provider Business Practice Location Address
First Line : 201 BRYSON AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-1922
Country : US
Telephone Number : 718-477-2184
Fax Number : 718-983-0348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/08/2007

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Directions to “ DR. LORNA AVILA MD” Practice Location

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