Provider Demographics
NPI:1275506685
Name:LIVEZEY, HEATHER K (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:LIVEZEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:1515 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3002
Practice Address - Country:US
Practice Address - Phone:973-873-7000
Practice Address - Fax:973-743-8943
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224300207L00000X
PAOS012720207L00000X
NJ25MB09237900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA478782OtherTUFTS ASSOC HEALTH PLANS
MAAA45658OtherHARVARD PILGRIM HEALTH
MAJ29387OtherBCBS OF MASS
MA966836OtherNETWORK HEALTH
MA2107805Medicaid
I37484Medicare UPIN
LI-A38948Medicare ID - Type Unspecified