Provider Demographics
NPI:1497297808
Name:LARIVIERE, JOY (FNP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 GIDNEY AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3741
Mailing Address - Country:US
Mailing Address - Phone:845-561-7075
Mailing Address - Fax:845-561-7006
Practice Address - Street 1:407B GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3702
Practice Address - Country:US
Practice Address - Phone:845-561-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-340902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily