Provider Demographics
NPI:1306216171
Name:UY, JEANETTE RIVERA
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:RIVERA
Last Name:UY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 84TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4739
Mailing Address - Country:US
Mailing Address - Phone:718-880-7857
Mailing Address - Fax:
Practice Address - Street 1:5545 84TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4739
Practice Address - Country:US
Practice Address - Phone:718-880-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY784660252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY930088244OtherGHI