Provider Demographics
NPI:1548667975
Name:TRIVIUM OF NEW YORK
Entity type:Organization
Organization Name:TRIVIUM OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:ONIKO
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:877-223-9228
Mailing Address - Street 1:90 HEATHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1405
Mailing Address - Country:US
Mailing Address - Phone:877-223-9228
Mailing Address - Fax:
Practice Address - Street 1:1216 E 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4928
Practice Address - Country:US
Practice Address - Phone:877-223-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health