Provider Demographics
NPI:1376673319
Name:RIVERVIEW PEDIATRICS
Entity Type:Organization
Organization Name:RIVERVIEW PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:TOMIAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:518-235-6181
Mailing Address - Street 1:315 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-3237
Mailing Address - Country:US
Mailing Address - Phone:518-235-6181
Mailing Address - Fax:518-237-2465
Practice Address - Street 1:315 2ND AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-3237
Practice Address - Country:US
Practice Address - Phone:518-235-6181
Practice Address - Fax:518-237-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130786208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty