1396233664 NPI number — DR. MARIOLA RIVERA PODIATRY, PLLC

Table of content: (NPI 1396233664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396233664 NPI number — DR. MARIOLA RIVERA PODIATRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. MARIOLA RIVERA PODIATRY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396233664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WINKLER FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10506-1733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-325-7414
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 MITCHELL PL STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10601-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-328-3400
Provider Business Practice Location Address Fax Number:
914-290-5795
Provider Enumeration Date:
04/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA MORELL
Authorized Official First Name:
MARIOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-325-7414

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  006721 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1093111866 . This is a "INDIVIDUAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com