Provider Demographics
NPI:1285995399
Name:LEV, AVITAL (MS ED)
Entity type:Individual
Prefix:
First Name:AVITAL
Middle Name:
Last Name:LEV
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3141
Mailing Address - Country:US
Mailing Address - Phone:914-207-9700
Mailing Address - Fax:
Practice Address - Street 1:10 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3141
Practice Address - Country:US
Practice Address - Phone:914-207-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357875195252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency