Provider Demographics
NPI:1255447371
Name:LIVA, DOUGLAS FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:FRANCIS
Last Name:LIVA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:625 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1913
Mailing Address - Country:US
Mailing Address - Phone:201-444-7770
Mailing Address - Fax:201-445-2570
Practice Address - Street 1:1 WEST RIDGEWOOD AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-444-7770
Practice Address - Fax:201-445-2570
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-01-10
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Provider Licenses
StateLicense IDTaxonomies
NJMA040964207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SBQ452359OtherPROV #
SBQ452359OtherPROV #
C55312Medicare UPIN