Provider Demographics
NPI:1174899900
Name:WAND, AVA ZVIYA
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:ZVIYA
Last Name:WAND
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 1:2 RUSSELL PL
Mailing Address - Street 2:P.S. 101
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5245
Mailing Address - Country:US
Mailing Address - Phone:718-268-7231
Mailing Address - Fax:
Practice Address - Street 1:2 RUSSELL PL
Practice Address - Street 2:P.S. 101
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5245
Practice Address - Country:US
Practice Address - Phone:718-268-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0002576-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics