Healthcare Provider Details

I. General information

NPI: 1912963885
Provider Name (Legal Business Name): JEFFREY SCOTT LIVA MD, MPH, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE SUITE G-1
PARAMUS NJ
07652-2359
US

IV. Provider business mailing address

1 W RIDGEWOOD AVE SUITE G-1
PARAMUS NJ
07652-2359
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-3060
  • Fax: 201-444-3933
Mailing address:
  • Phone: 201-444-3060
  • Fax: 201-444-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMA49009
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number205179-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number069231
License Number StateMI

VII. Legacy identifiers

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

# 1
Identifier133803BS8
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI
# 2
Identifier2K0321
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHNET

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: