Provider Demographics
NPI:1023866886
Name:PIVARNIK, PAUL DAVID (LMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:PIVARNIK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 QUEENS BLVD APT 605
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4964
Mailing Address - Country:US
Mailing Address - Phone:914-719-2444
Mailing Address - Fax:
Practice Address - Street 1:9002 QUEENS BLVD APT 605
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4964
Practice Address - Country:US
Practice Address - Phone:914-719-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029291225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist