1124263868 NPI number — DR. FREDERICK JOHN RIVERA LARMOR M. D.

Table of content: DR. FREDERICK JOHN RIVERA LARMOR M. D. (NPI 1124263868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124263868 NPI number — DR. FREDERICK JOHN RIVERA LARMOR M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARMOR
Provider First Name:
FREDERICK
Provider Middle Name:
JOHN RIVERA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
M

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:
1124263868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 ANGELA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-456-0410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 VETERAN'S MEMORIAL HWY
Provider Second Line Business Practice Location Address:
BLDG.151 NORTH COUNTY CLINIC
Provider Business Practice Location Address City Name:
HAUPPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-853-6410
Provider Business Practice Location Address Fax Number:
631-853-6413
Provider Enumeration Date:
12/10/2008

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: 2084P0802X , with the licence number:  146808-1 , 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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