MEDICARE: GENEVA VIVINO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	400496	NY

General Provider Information

NPI Number	:	1710925508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVA VIVINO NP

Provider Business Mailing Address
First Line	:	667 STONELEIGH AVE
Second Line	:	SUITE 202
City	:	CARMEL
State	:	NY
Zip	:	10512-2454
Country	:	US
Telephone Number	:	845-279-6381
Fax Number	:	845-279-5447

Provider Business Practice Location Address
First Line	:	667 STONELEIGH AVE
Second Line	:	SUITE 202
City	:	CARMEL
State	:	NY
Zip	:	10512-2454
Country	:	US
Telephone Number	:	845-279-5908
Fax Number	:	845-279-5447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	10/16/2009

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