Victoria Anne Petivan, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MA06516700 Issued in NJ

Practice address

100 Sullivan Way
West Trenton, NJ 08628

Phone

(609) 633-1502

Fax

(609) 777-0327

NPI assigned

Sep 1, 2006

Last updated

Oct 12, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• State of New Jersey Omb Centralized Payroll

  dba Trenton Psychiatric Hospital

  • Psychiatric Hospital
  • Trenton, NJ
  • NPI 1467552240
  Medicare reassignment NPD
• State of New Jersey Omb Centralized Payroll

  dba Greystone Park Psychiatric Hospital

  • Psychiatric Hospital
  • Morris Plains, NJ
  • NPI 1336221878
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444608000000",
    "number": "1457453383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SULLIVAN WAY",
            "city": "WEST TRENTON",
            "state": "NJ",
            "postal_code": "08628",
            "telephone_number": "609-633-1502",
            "fax_number": "609-777-0327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SULLIVAN WAY",
            "city": "WEST TRENTON",
            "state": "NJ",
            "postal_code": "08628",
            "telephone_number": "609-633-1502",
            "fax_number": "609-777-0327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETIVAN",
        "first_name": "VICTORIA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2015-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "MA06516700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7216203",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aida Rodrigo Nunez, M.D.
• Jennifer E Park, M.D.
• Partners Pharmacy LLC (Partners Pharmacy)
• Jayantilal Ramdas Patel, MD
• Soumya Patel
• Renee A Phifer, BCABA
• Carol A Pletnick, MA, ATR-BC, LPC
• PPS of NJ LLC
• Bhagyam Chenna Reddy, M. D.
• Amir M Rizvi, MD

• Psychiatry Physician in West Trenton, NJ
• Providers in West Trenton, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.