MEDICARE: DR. ERICK S TRIVEDI DDS

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	122300000X	Dentist	049545	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	:	1942356837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICK S TRIVEDI DDS

Provider Business Mailing Address
First Line	:	200 ALBANY AVE
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2531
Country	:	US
Telephone Number	:	631-842-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ALBANY AVE
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2501
Country	:	US
Telephone Number	:	631-842-0300
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/21/2014

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