Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 197583 | NY |
N | 207PP0204X | Pediatric Emergency Physician | MA06177700 | NJ |
NPI | 1538102710 |
---|---|
Provider Name | Dr. Usha Avva |
First Address | Paramus, NJ 07652-5603 |
Second Address | Nyack, NY 10960-1912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 30/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G38318 | (02) | NJ |