Provider Demographics
NPI:1912963885
Name:LIVA, JEFFREY SCOTT (MD, MPH, MS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:LIVA
Suffix:
Gender:M
Credentials:MD, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W RIDGEWOOD AVE
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2359
Mailing Address - Country:US
Mailing Address - Phone:201-444-3060
Mailing Address - Fax:201-444-3933
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE G-1
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-444-3060
Practice Address - Fax:201-444-3933
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA490092083X0100X
NY205179-12083X0100X
MI0692312083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
133803BS8OtherNPI
2K0321OtherHEALTHNET
F39825Medicare UPIN
527358Medicare ID - Type UnspecifiedMEDICARE