Healthcare Provider Details

I. General information

NPI: 1366898595
Provider Name (Legal Business Name): BIVIN GEORGE DO/PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LESTER DR
ORANGEBURG NY
10962-2331
US

IV. Provider business mailing address

45 LESTER DR
ORANGEBURG NY
10962-2331
US

V. Phone/Fax

Practice location:
  • Phone: 845-553-0858
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03727100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number061098
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: