Healthcare Provider Details

I. General information

NPI: 1104056589
Provider Name (Legal Business Name): LIVNAT ULIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1141
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1141
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1791
  • Fax: 212-831-2851
Mailing address:
  • Phone: 212-241-1791
  • Fax: 212-831-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number275472
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number275472
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number275472
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number275472
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: