Provider Demographics
NPI:1154818664
Name:RIVERA, KRYSTAL BALAGOT (DO)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:BALAGOT
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:BALAGOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:
Practice Address - Street 1:2339 ROUTE 70 W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3315
Practice Address - Country:US
Practice Address - Phone:856-795-3597
Practice Address - Fax:856-795-7590
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11155600207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program