Provider Demographics
NPI:1124263868
Name:LARMOR, FREDERICK JOHN RIVERA (M D)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOHN RIVERA
Last Name:LARMOR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ANGELA LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8903
Mailing Address - Country:US
Mailing Address - Phone:631-456-0410
Mailing Address - Fax:
Practice Address - Street 1:725 VETERAN'S MEMORIAL HWY
Practice Address - Street 2:BLDG.151 NORTH COUNTY CLINIC
Practice Address - City:HAUPPAGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-853-6410
Practice Address - Fax:631-853-6413
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146808-12084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry