Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 207324 | NY |
NPI | 1053353888 |
---|---|
Provider Name | Dr. Cecilia Avila |
First Address | Stony Brook, NY 11790-0989 |
Second Address | East Setauket, NY 11733-4047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 13/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02254199 | (05) | NY |
7019377 | AETNA (01) | NY |
728D31 | EMPIRE BC.BS (01) | NY |
H70445 | (02) | NY |