Provider Demographics
NPI:1275513897
Name:RIVAS, JAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYNE
Middle Name:
Last Name:RIVAS
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:PO BOX 5070 GENERAL PO
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:153 W 11TH ST
Practice Address - Street 2:SMITH 834
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8305
Practice Address - Country:US
Practice Address - Phone:212-604-7879
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120423173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364230Medicaid
NY02364230Medicaid