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General NPI Number Information
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NPI Number | 1174774145
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Entity Type | Individual
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Provider Name | DAVID VIERA PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 1065 TOOKER AVE.
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City | WEST BABYLON
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State | NY
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Zip | 11704-5047
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Country | US
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Telephone | 631-587-1029
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 TOOKER AVE WEST BABYLON
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City | NEW YORK
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State | NY
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Zip | 11704-5047
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Country | US
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Telephone | 631-587-1029
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Fax | 631-587-1029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001211-1
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License Number State | NY
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