Provider Demographics
NPI:1407490139
Name:LITVINOVA, LARISA
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:LITVINOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6402
Mailing Address - Country:US
Mailing Address - Phone:212-769-7847
Mailing Address - Fax:212-769-4213
Practice Address - Street 1:250 W 64TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6402
Practice Address - Country:US
Practice Address - Phone:212-769-7847
Practice Address - Fax:212-769-4213
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489420163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse