Provider Demographics
NPI:1992091060
Name:LIVINGSTONE, ESTHER ANN (MD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:ANN
Last Name:LIVINGSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 TOWNSHIP BLVD.
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031
Mailing Address - Country:US
Mailing Address - Phone:315-487-1081
Mailing Address - Fax:315-870-3893
Practice Address - Street 1:270 TOWNSHIP BLVD.
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031
Practice Address - Country:US
Practice Address - Phone:315-487-1081
Practice Address - Fax:315-870-3893
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260593261QP2300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03365299Medicaid