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NPI Code Detail

MEDICARE: MS. AVIVIT SHALOM

MEDICARE: MS. AVIVIT SHALOM
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
1225200000XPhysical Therapy Assistant007937-1NY

General Provider Information

NPI Number : 1780954255
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AVIVIT SHALOM
Provider Business Mailing Address
First Line : 2104 PROSPECT AVENUE
Second Line :
City : EAST MEADOW
State : NY
Zip : 11554
Country : US
Telephone Number : 516-263-6391
Fax Number :
Provider Business Practice Location Address
First Line : 310 NATIONAL BLVD
Second Line :
City : LONG BEACH
State : NY
Zip : 11561-3326
Country : US
Telephone Number : 516-431-2929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2011
Last Update Date : 12/30/2011

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Directions to “ MS. AVIVIT SHALOM ” Practice Location

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