Individual
LAVIZAN BALDEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9 NORTON AVE, PORT JEFFERSON STATION, NY 11776-4407
(631) 474-7878
Mailing address
8 ESTHER CT, PATCHOGUE, NY 11772-1814
(631) 289-5797
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
536970-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DU32484Y
—
NY
Enumeration date
05/28/2008
Last updated
05/28/2008
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