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NPI Code Detail

MEDICARE: MRS. DEBORAH MARTIN-AVILA PA-C

MEDICARE: MRS. DEBORAH MARTIN-AVILA PA-C
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
1363A00000XPhysician Assistant0010-00318NC
2363A00000XPhysician Assistant013186NY

General Provider Information

NPI Number : 1679535124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEBORAH MARTIN-AVILA PA-C
Provider Business Mailing Address
First Line : 110 W 97TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10025-6450
Country : US
Telephone Number : 212-749-1820
Fax Number : 212-932-8323
Provider Business Practice Location Address
First Line : 110 W 97TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10025-6450
Country : US
Telephone Number : 212-749-1820
Fax Number : 212-932-8323
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 12/07/2009

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Directions to “ MRS. DEBORAH MARTIN-AVILA PA-C” Practice Location

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