Individual
MARIAM M KIRVALIDZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
181 N BELLE MEAD RD STE 2, EAST SETAUKET, NY 11733-3495
(631) 444-5858
(631) 444-1899
Mailing address
1033 NORTHERN BLVD, ROSLYN, NY 11576-1502
(516) 473-0782
(516) 253-2150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
310737
NY
Other
Enumeration date
04/16/2018
Last updated
09/25/2022
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