Provider Demographics
NPI:1386602084
Name:AVIGDOR, NEFTALI Z
Entity type:Individual
Prefix:DR
First Name:NEFTALI
Middle Name:Z
Last Name:AVIGDOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10230 66TH RD APT 7B
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7617
Mailing Address - Country:US
Mailing Address - Phone:718-381-5600
Mailing Address - Fax:718-456-1068
Practice Address - Street 1:333 KNICKERBOCKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3601
Practice Address - Country:US
Practice Address - Phone:718-381-5600
Practice Address - Fax:718-456-1068
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158911208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG04375Medicare UPIN