Provider Demographics
NPI:1275819732
Name:RIVERA, SEETHA MANEYAPANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SEETHA
Middle Name:MANEYAPANDA
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 1:215 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1328
Mailing Address - Country:US
Mailing Address - Phone:862-955-3183
Mailing Address - Fax:862-955-3189
Practice Address - Street 1:215 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1328
Practice Address - Country:US
Practice Address - Phone:862-955-3183
Practice Address - Fax:862-955-1389
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09048800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0362921Medicaid