Healthcare Provider Details

I. General information

NPI: 1992750244
Provider Name (Legal Business Name): BIRENDRA KUMAR TRIVEDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N BROADWAY STE 2
MASSAPEQUA NY
11758-2303
US

IV. Provider business mailing address

4230 HEMPSTEAD TPKE. SUITE106
BETHPAGE NY
11714-3566
US

V. Phone/Fax

Practice location:
  • Phone: 516-520-5507
  • Fax: 516-520-5493
Mailing address:
  • Phone: 516-520-5507
  • Fax: 516-520-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number209199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: