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1619061975
AVITAL FAST
BRONX, NY
NPI
1619061975
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208100000X Physical Medicine & Rehabilitation
(Licence: NY 167979)
Enumeration Date
2006-10-03
Last Update Date
2007-07-08
Business Address
AVITAL FAST MD
MMC - DEPT. OF REHAB MEDICINE 111 EAST 210TH STREET
BRONX, NY 10467
Phone number: 718-920-2751
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Mailing Address
AVITAL FAST MD
16 SOUTHLAND DR
GLEN COVE, NY 11542-1012
Phone number: 718-920-2751
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