Provider Demographics
NPI:1104181346
Name:TUTIVEN, EDWARD BENJAMIN (MS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:BENJAMIN
Last Name:TUTIVEN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 THIRD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1425
Mailing Address - Country:US
Mailing Address - Phone:646-387-5613
Mailing Address - Fax:
Practice Address - Street 1:22 THIRD AVE FL 2
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1425
Practice Address - Country:US
Practice Address - Phone:646-387-5613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist