MEDICARE: DR. VIVIANE MARIE ANNE ETIENNE M.D

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	207R00000X	Internal Medicine Physician	185097	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	:	1699983585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIANE MARIE ANNE ETIENNE M.D

Provider Business Mailing Address
First Line	:	8 WILLOWBROOK LN
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-1327
Country	:	US
Telephone Number	:	516-665-8139
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 WARREN ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1734
Country	:	US
Telephone Number	:	718-651-7175
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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