Healthcare Provider Details

I. General information

NPI: 1164994034
Provider Name (Legal Business Name): VIVE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 OCEAN PKWY
BROOKLYN NY
11230-5155
US

IV. Provider business mailing address

1 IRVING PL APT U20E
NEW YORK NY
10003-9729
US

V. Phone/Fax

Practice location:
  • Phone: 718-500-3505
  • Fax:
Mailing address:
  • Phone: 305-929-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MAYA KORCH
Title or Position: MANAGER
Credential:
Phone: 305-929-3376