Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N003929-1 | NY |
Y | 222Z00000X | Podiatrist | N003929-1 | NY |
NPI | 1063411288 |
---|---|
Provider Name | Dr. Maryann Z Trivlis |
First Address | Brooklyn, NY 11229-1520 |
Second Address | Brooklyn, NY 11229-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00909839 | (05) | NY |
T31751 | (02) | NY |