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General NPI Number Information
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NPI Number | 1215174099
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Entity Type | Individual
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Provider Name | ADRIENNE M. VIVIANO P.A.
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Gender | Female
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 375 SEGUINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3932
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Country | US
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Telephone | 718-226-2377
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Fax |
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Provider Business Mailing Address
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Address Line | 64 LAREDO AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3430
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Country | US
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Telephone |
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00101800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 008946
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License Number State | NY
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