Provider Demographics
NPI:1063780666
Name:MARSHEL, AVIGDOR (OT)
Entity type:Individual
Prefix:
First Name:AVIGDOR
Middle Name:
Last Name:MARSHEL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2553
Mailing Address - Country:US
Mailing Address - Phone:718-630-7425
Mailing Address - Fax:718-630-7604
Practice Address - Street 1:5800 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3702
Practice Address - Country:US
Practice Address - Phone:718-630-6180
Practice Address - Fax:718-630-7437
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist