Provider Demographics
NPI:1114275187
Name:OCTAVIEN, LUCIEN
Entity Type:Individual
Prefix:
First Name:LUCIEN
Middle Name:
Last Name:OCTAVIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FRANCOISE
Other - Middle Name:ANN
Other - Last Name:OCTAVIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:75 1ER ANE BOLOSSE
Mailing Address - Street 2:
Mailing Address - City:PORT-AU-PRINCE
Mailing Address - State:CAPITAL
Mailing Address - Zip Code:WI
Mailing Address - Country:HT
Mailing Address - Phone:509-103-5339
Mailing Address - Fax:
Practice Address - Street 1:255 WARNER AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1000
Practice Address - Country:US
Practice Address - Phone:516-621-5400
Practice Address - Fax:516-621-4879
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31055-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse