Provider Demographics
NPI:1730390808
Name:MAGIDOFF, AVI (LAC)
Entity type:Individual
Prefix:
First Name:AVI
Middle Name:
Last Name:MAGIDOFF
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4869
Mailing Address - Country:US
Mailing Address - Phone:603-531-3130
Mailing Address - Fax:
Practice Address - Street 1:133 PEARSON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4869
Practice Address - Country:US
Practice Address - Phone:603-531-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4301171100000X
NHACP-051171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist