Provider Demographics
NPI:1659426500
Name:PREVENTIVE PLUS P.A.
Entity Type:Organization
Organization Name:PREVENTIVE PLUS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-3060
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-0029
Mailing Address - Country:US
Mailing Address - Phone:201-444-3060
Mailing Address - Fax:201-447-9338
Practice Address - Street 1:1 WEST RIDGEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-444-3060
Practice Address - Fax:201-447-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527358Medicare PIN