Provider Demographics
NPI:1275692725
Name:HERMAN RIVERA, BEVERLY A (RD CDE)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:A
Last Name:HERMAN RIVERA
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452
Mailing Address - Country:US
Mailing Address - Phone:201-445-1460
Mailing Address - Fax:201-445-1460
Practice Address - Street 1:140 DEAN ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452
Practice Address - Country:US
Practice Address - Phone:201-445-1460
Practice Address - Fax:201-445-1460
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
NJ2041-0164133NN1002X
NJ882506CDR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
7567402OtherAETNA TRADITIONAL
7619063OtherCIGNA
NJP2633343OtherOXFORD
NJP2633340OtherOXFORD
P2633343OtherOXFORD RD
3059850OtherAETNA HMO
P2633340OtherOXFORD NUTR