Provider Demographics
NPI:1457083859
Name:RIVERA, FREDERICK BERRO (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:BERRO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 QUEENS BLVD APT 330
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4960
Mailing Address - Country:US
Mailing Address - Phone:929-855-9083
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST # 8-20
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-4739
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program