Provider Demographics
NPI:1447308879
Name:LAVIOLA, FRANKLIN NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:NICHOLAS
Last Name:LAVIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 ISLIP AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1826
Mailing Address - Country:US
Mailing Address - Phone:631-581-8152
Mailing Address - Fax:631-277-8660
Practice Address - Street 1:499 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1826
Practice Address - Country:US
Practice Address - Phone:631-581-8152
Practice Address - Fax:631-277-8660
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1062302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00186374Medicaid
NY00186374Medicaid
NY951281Medicare ID - Type Unspecified