Individual
SUSAN DE VIVIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2201 HEMPSTEAD TPKE, EAST MEADOW, NY 11554-1859
(516) 572-6177
Mailing address
2201 HEMPSTEAD TPKE, EAST MEADOW, NY 11554-1859
(516) 572-6177
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
292543
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02724541
—
NY
Enumeration date
06/30/2006
Last updated
04/10/2008
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