Provider Demographics
NPI:1710982731
Name:DUVIVIER, HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:
Last Name:DUVIVIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:3085 HARLEM RD STE 300
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2594
Practice Address - Country:US
Practice Address - Phone:716-442-5422
Practice Address - Fax:716-422-5420
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281298207RH0003X
MN75658207RH0003X
NY277161207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04148472Medicaid
E98362Medicare UPIN
202951427OtherTAX ID
E98362Medicare UPIN