Provider Demographics
NPI:1982786893
Name:LIVSHITS, LARISA L (MD)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:L
Last Name:LIVSHITS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARISA
Other - Middle Name:L
Other - Last Name:LEONIDOVNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:245 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073
Mailing Address - Country:US
Mailing Address - Phone:973-882-3545
Mailing Address - Fax:973-882-0457
Practice Address - Street 1:150 FAIRFIELD ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004
Practice Address - Country:US
Practice Address - Phone:973-227-0020
Practice Address - Fax:973-808-3320
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07270800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43699Medicare UPIN