Provider Demographics
NPI:1346455078
Name:TRIVEDI, NARENDRA K (MD)
Entity Type:Individual
Prefix:
First Name:NARENDRA
Middle Name:K
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:221 BROADWAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2780
Mailing Address - Country:US
Mailing Address - Phone:631-691-0210
Mailing Address - Fax:516-822-2290
Practice Address - Street 1:221 BROADWAY
Practice Address - Street 2:SUITE 304
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2780
Practice Address - Country:US
Practice Address - Phone:631-691-0210
Practice Address - Fax:516-822-2290
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1218732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY712011Medicare ID - Type Unspecified