Provider Demographics
NPI:1558443739
Name:LITVINOVA, LARISA (MD)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:LITVINOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2787
Mailing Address - Country:US
Mailing Address - Phone:646-202-2968
Mailing Address - Fax:718-857-8415
Practice Address - Street 1:110 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2787
Practice Address - Country:US
Practice Address - Phone:646-202-2968
Practice Address - Fax:718-857-8415
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08481700207R00000X
NY219127207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY151AQ1Medicare PIN
NYH94163Medicare UPIN