MEDICARE: RELIABLE NP IN FAMILY HEALTH

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1376068312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE NP IN FAMILY HEALTH

Provider Business Mailing Address
First Line	:	523 MILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 MILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5533
Country	:	US
Telephone Number	:	718-629-8133
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIA LIVSHTIS
Credential	:	NP
Telephone Number	:	718-629-8133

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	08/10/2017

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