Healthcare Provider Details

I. General information

NPI: 1134324221
Provider Name (Legal Business Name): EUGENE MARIUS CAUVIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 BROADWAY STE 300
NEW YORK NY
10019-1903
US

IV. Provider business mailing address

114 E 98TH ST APT 4R
NEW YORK NY
10029-6766
US

V. Phone/Fax

Practice location:
  • Phone: 917-304-4589
  • Fax:
Mailing address:
  • Phone: 212-831-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: