Provider Demographics
NPI:1033998364
Name:RIVERA, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2654
Mailing Address - Country:US
Mailing Address - Phone:845-645-5751
Mailing Address - Fax:
Practice Address - Street 1:3 SHODDY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:OTISVILLE
Practice Address - State:NY
Practice Address - Zip Code:10963-2819
Practice Address - Country:US
Practice Address - Phone:845-645-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator