Basic Information
| Provider Information | |||||||||
| NPI: | 1396729984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAVASIS | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 356 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100114401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122717200 | ||||||||
| FaxNumber: | 2122718111 | ||||||||
| Practice Location | |||||||||
| Address1: | 356 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100114401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122717200 | ||||||||
| FaxNumber: | 2122718111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0000X | 194759 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
No ID Information.