Provider Demographics
NPI:1477862225
Name:KRIVIT, SAMUEL B (RPA-C)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:B
Last Name:KRIVIT
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEW YORK BRAIN AND SPINE SURGERY
Mailing Address - Street 2:HSC T12 ROOM 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:516-993-5947
Mailing Address - Fax:
Practice Address - Street 1:HSC T12 RM 080
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8122
Practice Address - Country:US
Practice Address - Phone:631-444-8070
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9105657363A00000X
NY014711363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant