Provider Demographics
NPI:1700932761
Name:LIVELLI, FRANK DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:DAVID
Last Name:LIVELLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:311 OAKDENE AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2025
Mailing Address - Country:US
Mailing Address - Phone:201-461-5959
Mailing Address - Fax:201-461-0839
Practice Address - Street 1:311 OAKDENE AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-2025
Practice Address - Country:US
Practice Address - Phone:201-461-5959
Practice Address - Fax:201-461-0839
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03790000207RC0000X
NY135659207RC0001X, 207UN0901X, 207RC0200X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00606542Medicaid
NYB15534Medicare UPIN
NY00606542Medicaid