Provider Demographics
NPI:1396780714
Name:CALEV, AVRAHAM (PHD)
Entity type:Individual
Prefix:
First Name:AVRAHAM
Middle Name:
Last Name:CALEV
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SMITHTOWN BYP
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2524
Mailing Address - Country:US
Mailing Address - Phone:631-361-7389
Mailing Address - Fax:631-246-5469
Practice Address - Street 1:152 ISLIP AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3225
Practice Address - Country:US
Practice Address - Phone:631-361-7389
Practice Address - Fax:631-361-7389
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0109532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01344710Medicaid
NMV6B372Medicare ID - Type UnspecifiedEMPIRE MEDICARE #