Healthcare Provider Details

I. General information

NPI: 1063411288
Provider Name (Legal Business Name): MARYANN Z TRIVLIS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 BEACH 138TH ST
BELLE HARBOR NY
11694-1337
US

IV. Provider business mailing address

131 BEACH 138TH ST
BELLE HARBOR NY
11694-1337
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-0770
  • Fax: 718-945-7938
Mailing address:
  • Phone: 718-945-0770
  • Fax: 718-945-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003929-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: