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General NPI Number Information
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NPI Number | 1205016110
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Entity Type | Organization
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Legal Business Name | KIRAN TRIVEDI DO PLLC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 1 GRANT AVE
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City | ISLIP
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State | NY
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Zip | 11751-3543
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Country | US
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Telephone | 631-859-1920
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Fax | 631-859-5019
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Provider Business Mailing Address
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Address Line | 26 RAILROAD AVE # 202
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City | BABYLON
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State | NY
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Zip | 11702-2204
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Country | US
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Telephone | 631-859-1920
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Fax | 631-859-5019
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KIRAN TRIVEDI
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Credential | D.O.
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Telephone | 631-859-1920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 237997-1
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License Number State | NY
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