Provider Demographics
NPI:1124034400
Name:NIVERA, NOEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:T
Last Name:NIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 INDUSTRIAL WAY WEST
Mailing Address - Street 2:STE B HYPERTENSION & NEPHROLOGY ASSOC
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:732-460-1200
Mailing Address - Fax:732-460-1211
Practice Address - Street 1:6 INDUSTRIAL WAY WEST
Practice Address - Street 2:STE B HYPERTENSION & NEPHROLOGY ASSOC
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:732-460-1200
Practice Address - Fax:732-460-1211
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68739207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7892306Medicaid
024783A5NMedicare ID - Type Unspecified
G88234Medicare UPIN