1417999533 NPI number — DR. LOUIS J AVVENTO MD

Table of content: DR. LOUIS J AVVENTO MD (NPI 1417999533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417999533 NPI number — DR. LOUIS J AVVENTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVVENTO
Provider First Name:
LOUIS
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417999533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 ROUTE 112 BLDG 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JEFFERSON STATION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11776-8055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-751-0000
Provider Business Mailing Address Fax Number:
631-509-6559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 COUNTY ROAD 39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11968-5219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-751-3000
Provider Business Practice Location Address Fax Number:
631-509-6559
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  161779 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 830007838 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01104521 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14B862 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".