Healthcare Provider Details

I. General information

NPI: 1982586749
Provider Name (Legal Business Name): VIVIENNE ANN-MARIE FALCONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 FIR ST
VALLEY STREAM NY
11580-5018
US

IV. Provider business mailing address

62 FIR ST
VALLEY STREAM NY
11580-5018
US

V. Phone/Fax

Practice location:
  • Phone: 516-673-6906
  • Fax: 718-978-0032
Mailing address:
  • Phone: 516-673-6906
  • Fax: 718-978-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number465286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: