Provider Demographics
NPI:1396821583
Name:RIVAS MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:RIVAS MEDICAL SUPPLIES LLC
Other - Org Name:RIVAS MEDICAL SUPPLIES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-249-8989
Mailing Address - Street 1:1950 RUTGERS UNIVERSITY BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4537
Mailing Address - Country:US
Mailing Address - Phone:973-249-8989
Mailing Address - Fax:732-657-9400
Practice Address - Street 1:1950 RUTGERS UNIVERSITY BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4537
Practice Address - Country:US
Practice Address - Phone:973-249-8989
Practice Address - Fax:732-657-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010003142-01OtherAMERICHOICE OF NEW JERSEY
NJ29560OtherUNIVERSITY HEALTHPLAN OF NEW JERSEY
NJ43ZA00019700OtherRESPIRATORY THERAPIST
NJA2403335OtherOXFORD HEALTH PLAN
NJ2507716OtherAETNA USHEALTHCARE
NJ38627OtherIDA INSURANCE COMPANY
NJ8520607Medicaid
NJ2059451OtherUNITED HEALTHCARE
NJCFORM0569OtherCERTIFIED ORTHOTIC & MASTECTOMY FITTER
NJ28RW01086500OtherCERTIFIED PHARMACY TECHNICIAN
NJ88349OtherAMERIGROUP OF NEW JERSEY
NJ8520607Medicaid
NJ8520607Medicaid