Healthcare Provider Details

I. General information

NPI: 1710925508
Provider Name (Legal Business Name): GENEVA VIVINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE SUITE 202
CARMEL NY
10512-2454
US

IV. Provider business mailing address

667 STONELEIGH AVE SUITE 202
CARMEL NY
10512-2454
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5908
  • Fax: 845-279-5447
Mailing address:
  • Phone: 845-279-6381
  • Fax: 845-279-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: