Provider Demographics
NPI:1215507819
Name:AVANT MEDICAL GROUP LLP
Entity type:Organization
Organization Name:AVANT MEDICAL GROUP LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAYKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-245-6893
Mailing Address - Street 1:233 BROADWAY RM 2750
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10279-2704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 BROADWAY RM 2750
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10279-2704
Practice Address - Country:US
Practice Address - Phone:212-245-6893
Practice Address - Fax:212-481-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty