Provider Demographics
NPI:1487888251
Name:MARC AVVENTO DC PC
Entity type:Organization
Organization Name:MARC AVVENTO DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT/ CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:AVVENTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-744-2114
Mailing Address - Street 1:691 ROUTE 25A
Mailing Address - Street 2:C/O THE BODY SHOP
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2643
Mailing Address - Country:US
Mailing Address - Phone:631-744-2114
Mailing Address - Fax:631-744-2114
Practice Address - Street 1:691 ROUTE 25A
Practice Address - Street 2:C/O THE BODY SHOP
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2643
Practice Address - Country:US
Practice Address - Phone:631-744-2114
Practice Address - Fax:631-744-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011602-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization