Provider Demographics
NPI:1366437790
Name:LIKVER, LARISA N (MD)
Entity type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:N
Last Name:LIKVER
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 1:181 COLERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4130
Mailing Address - Country:US
Mailing Address - Phone:718-259-0199
Mailing Address - Fax:718-256-0109
Practice Address - Street 1:8419 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3303
Practice Address - Country:US
Practice Address - Phone:718-259-0199
Practice Address - Fax:718-256-0109
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216637208100000X
NJMA070167208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02077278Medicaid
H14327Medicare UPIN
NY02077278Medicaid