Healthcare Provider Details

I. General information

NPI: 1386568244
Provider Name (Legal Business Name): LIANA GRAY VICARI NP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 NORTHERN BLVD
MANHASSET NY
11030-3053
US

IV. Provider business mailing address

500 E 77TH ST APT 2117
NEW YORK NY
10162-0008
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-2229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF357487-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: