MEDICARE: MS. TOVA CHAVIV TOV CHAVIV

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	163WD0400X	Diabetes Educator Registered Nurse	556106-1	NY
2	163WD0400X	Diabetes Educator Registered Nurse	F337015-1	NY

General Provider Information

NPI Number	:	1861778409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TOVA CHAVIV TOV CHAVIV

Provider Business Mailing Address
First Line	:	27110 GRAND CENTRAL PKWY
Second Line	:	4G
City	:	FLORAL PARK
State	:	NY
Zip	:	11005-1245
Country	:	US
Telephone Number	:	812-630-2460
Fax Number	:

Provider Business Practice Location Address
First Line	:	27110 GRAND CENTRAL PKWY
Second Line	:	4G
City	:	FLORAL PARK
State	:	NY
Zip	:	11005-1245
Country	:	US
Telephone Number	:	812-630-2460
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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