Provider Demographics
NPI:1962125658
Name:BIR, AVA DIANE
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:DIANE
Last Name:BIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 95TH ST APT 33
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6363
Mailing Address - Country:US
Mailing Address - Phone:703-470-2011
Mailing Address - Fax:
Practice Address - Street 1:155 W 72ND ST RM 505
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3250
Practice Address - Country:US
Practice Address - Phone:917-497-2760
Practice Address - Fax:917-497-2760
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program