Provider Demographics
NPI:1235120213
Name:RIVERA, VELMINA S (MD)
Entity Type:Individual
Prefix:DR
First Name:VELMINA
Middle Name:S
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N BROADWAY FL 10
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1122
Mailing Address - Country:US
Mailing Address - Phone:856-614-5610
Mailing Address - Fax:856-614-3236
Practice Address - Street 1:130 N BROADWAY
Practice Address - Street 2:10TH FLOOR
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1122
Practice Address - Country:US
Practice Address - Phone:856-614-5610
Practice Address - Fax:856-614-3236
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066032002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN