Healthcare Provider Details

I. General information

NPI: 1245293877
Provider Name (Legal Business Name): PAUL A LIVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 SUMMIT AVE
HACKENSACK NJ
07601-1414
US

IV. Provider business mailing address

391 SUMMIT AVE
HACKENSACK NJ
07601-1414
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-5191
  • Fax: 201-487-0026
Mailing address:
  • Phone: 201-342-5191
  • Fax: 201-487-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA03541600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: