Provider Demographics
NPI:1134644032
Name:RIVIA MEDICAL PLLC
Entity Type:Organization
Organization Name:RIVIA MEDICAL PLLC
Other - Org Name:RIVIA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN AO DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-203-1773
Mailing Address - Street 1:274 MADISON AVE RM 1501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0701
Mailing Address - Country:US
Mailing Address - Phone:212-203-1773
Mailing Address - Fax:646-665-4427
Practice Address - Street 1:274 MADISON AVE RM 1501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0701
Practice Address - Country:US
Practice Address - Phone:212-203-1773
Practice Address - Fax:646-665-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2854062084P0800X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty