Provider Demographics
NPI:1467437707
Name:LIVITZ, INNA (DO)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:LIVITZ
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 1:2631 MERRICK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5730
Mailing Address - Country:US
Mailing Address - Phone:516-809-9500
Mailing Address - Fax:516-308-3444
Practice Address - Street 1:2631 MERRICK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5730
Practice Address - Country:US
Practice Address - Phone:516-809-9500
Practice Address - Fax:516-308-3444
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5527B1Medicare ID - Type Unspecified
NYH95200Medicare UPIN