Provider Demographics
NPI:1063571560
Name:BIVONA, JAMES JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:BIVONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2905
Mailing Address - Country:US
Mailing Address - Phone:516-887-7232
Mailing Address - Fax:
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5359
Practice Address - Country:US
Practice Address - Phone:203-325-2667
Practice Address - Fax:203-973-0446
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH32110Medicare UPIN
CT110008168Medicare ID - Type Unspecified