Provider Demographics
NPI:1033660196
Name:DAVID VIVAS, PHYSICIAN, PC
Entity Type:Organization
Organization Name:DAVID VIVAS, PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:516-478-4540
Mailing Address - Street 1:1075 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2930
Mailing Address - Country:US
Mailing Address - Phone:516-478-4540
Mailing Address - Fax:516-248-5031
Practice Address - Street 1:1075 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2930
Practice Address - Country:US
Practice Address - Phone:516-478-4540
Practice Address - Fax:516-248-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284005208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty