Provider Demographics
NPI:1356019434
Name:RIVERSIDE PHYSICAL MEDICINE P.C.
Entity Type:Organization
Organization Name:RIVERSIDE PHYSICAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-469-4356
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0833
Mailing Address - Country:US
Mailing Address - Phone:917-648-1779
Mailing Address - Fax:855-347-7879
Practice Address - Street 1:59-61 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1657
Practice Address - Country:US
Practice Address - Phone:908-469-4356
Practice Address - Fax:855-347-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1184795916OtherKEVIN GUINTA