Healthcare Provider Details

I. General information

NPI: 1023156163
Provider Name (Legal Business Name): CAROL ANNE LIVOTI M.D.,F.A.C.O.G.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 GRAND CONCOURSE
BRONX NY
10453-4303
US

IV. Provider business mailing address

2626 HALPERIN AVE
BRONX NY
10461-2631
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-7295
  • Fax: 718-299-6797
Mailing address:
  • Phone: 718-618-0401
  • Fax: 347-479-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number104627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: