Provider Demographics
NPI:1144573817
Name:JOSEPH LIVOTI MD PC
Entity Type:Organization
Organization Name:JOSEPH LIVOTI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVOTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-661-6041
Mailing Address - Street 1:400 MONTAUK HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4429
Mailing Address - Country:US
Mailing Address - Phone:631-661-6041
Mailing Address - Fax:
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-661-6041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01565957Medicaid
NY01565957Medicaid