Provider Demographics
NPI:1982927489
Name:STONE, VIVINE MARCIA (DNAP,CRNA)
Entity Type:Individual
Prefix:
First Name:VIVINE
Middle Name:MARCIA
Last Name:STONE
Suffix:
Gender:F
Credentials:DNAP,CRNA
Other - Prefix:
Other - First Name:VIVINE
Other - Middle Name:MARCIA
Other - Last Name:SENIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNAP, CRNA
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3107
Mailing Address - Fax:
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1652
Practice Address - Country:US
Practice Address - Phone:914-493-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY530769367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03192303Medicaid
NYA400029075Medicare PIN