Provider Demographics
NPI:1245293877
Name:LIVA, PAUL A (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:LIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:391 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1414
Mailing Address - Country:US
Mailing Address - Phone:201-342-5191
Mailing Address - Fax:201-487-0026
Practice Address - Street 1:391 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1414
Practice Address - Country:US
Practice Address - Phone:201-342-5191
Practice Address - Fax:201-487-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03541600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4804560001Medicare NSC
D19450Medicare UPIN