MEDICARE: DR. MARYANN Z TRIVLIS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N003929-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063411288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYANN Z TRIVLIS DPM

Provider Business Mailing Address
First Line	:	131 BEACH 138TH ST
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1337
Country	:	US
Telephone Number	:	718-945-0770
Fax Number	:	718-945-7938

Provider Business Practice Location Address
First Line	:	131 BEACH 138TH ST
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1337
Country	:	US
Telephone Number	:	718-945-0770
Fax Number	:	718-945-7938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/09/2022

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