Healthcare Provider Details

I. General information

NPI: 1528351061
Provider Name (Legal Business Name): PALLAVI SRIVASTAVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JERICHO TPKE
SYOSSET NY
11791-4515
US

IV. Provider business mailing address

68 SOUTH SERVICE ROAD SUITE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-6400
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number262102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: