Provider Demographics
NPI:1174774145
Name:VIERA, DAVID (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:VIERA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 TOOKER AVE
Mailing Address - Street 2:WEST BABYLON
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5047
Mailing Address - Country:US
Mailing Address - Phone:631-587-1029
Mailing Address - Fax:631-587-1029
Practice Address - Street 1:1065 TOOKER AVE.
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5047
Practice Address - Country:US
Practice Address - Phone:631-587-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001211-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical