Healthcare Provider Details

I. General information

NPI: 1073424818
Provider Name (Legal Business Name): JHARLINE CARMEN VIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 FULTON AVE
HEMPSTEAD NY
11550-3923
US

IV. Provider business mailing address

11841 METROPOLITAN AVE APT 3E
KEW GARDENS NY
11415-2074
US

V. Phone/Fax

Practice location:
  • Phone: 516-538-2613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: