Provider Demographics
NPI:1316000334
Name:RIVERO, RUBEN (DC)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:RIVERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 FRANK RODGERS BLVD NORTH
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029
Mailing Address - Country:US
Mailing Address - Phone:973-482-4404
Mailing Address - Fax:973-482-6921
Practice Address - Street 1:211 FRANK RODGERS BLVD NORTH
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029
Practice Address - Country:US
Practice Address - Phone:973-482-4404
Practice Address - Fax:973-482-6921
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00227100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ188004Medicaid
NJ188004Medicaid