Provider Demographics
NPI:1417191230
Name:OPTIMUM CARE FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:OPTIMUM CARE FAMILY MEDICINE, LLC
Other - Org Name:NICHOLAS LIVRIERI, M.D. P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVRIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-4606
Mailing Address - Street 1:321 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-265-4606
Mailing Address - Fax:631-265-4675
Practice Address - Street 1:321 MIDDLE COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-4606
Practice Address - Fax:631-265-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094454207Q00000X
NY238064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty