Provider Demographics
NPI:1720409766
Name:KIJAC, LIVIA STEPHANIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LIVIA
Middle Name:STEPHANIA
Last Name:KIJAC
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:P.O. BOX 4823
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831
Mailing Address - Country:US
Mailing Address - Phone:914-500-7986
Mailing Address - Fax:914-273-9223
Practice Address - Street 1:10 DWIGHT LANE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:914-500-7986
Practice Address - Fax:914-273-9223
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1339012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry