Provider Demographics
NPI:1023371879
Name:RIVERA, GEORGE JASON (MSED)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JASON
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PALMER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3319
Mailing Address - Country:US
Mailing Address - Phone:917-693-8705
Mailing Address - Fax:
Practice Address - Street 1:821 PALMER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3319
Practice Address - Country:US
Practice Address - Phone:917-693-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency