1770140618 NPI number — VIVIANA ROSA DADD NP

Table of content: VIVIANA ROSA DADD NP (NPI 1770140618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770140618 NPI number — VIVIANA ROSA DADD NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DADD
Provider First Name:
VIVIANA
Provider Middle Name:
ROSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770140618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11350 MCCORMICK RD
Provider Second Line Business Mailing Address:
EXECUTIVE PLAZA 1, SUITE 501
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-329-1071
Provider Business Mailing Address Fax Number:
410-329-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-8814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-228-5802
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  344821 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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