Provider Demographics
NPI:1013279827
Name:TRIVILINO, CRISTINA L (MED, SAS)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:L
Last Name:TRIVILINO
Suffix:
Gender:F
Credentials:MED, SAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 EAST HILL RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-526-0760
Mailing Address - Fax:
Practice Address - Street 1:34 E HILL RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1071
Practice Address - Country:US
Practice Address - Phone:914-526-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPERMANENT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist