Provider Demographics
NPI:1306010335
Name:RIVERVIEW HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:RIVERVIEW HEALTHCARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JURADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-867-5791
Mailing Address - Street 1:2401 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4528
Mailing Address - Country:US
Mailing Address - Phone:201-867-5791
Mailing Address - Fax:201-223-1905
Practice Address - Street 1:2401 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4528
Practice Address - Country:US
Practice Address - Phone:201-867-5791
Practice Address - Fax:201-223-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2020-05-20
Deactivation Date:2020-01-28
Deactivation Code:
Reactivation Date:2020-05-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7489609Medicaid
NJ6689507Medicaid
NJ004109M39Medicare PIN
NJ6689507Medicaid