Provider Demographics
NPI:1508073362
Name:RIVERA, ADALIZ (MD)
Entity Type:Individual
Prefix:
First Name:ADALIZ
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7001
Mailing Address - Country:US
Mailing Address - Phone:609-572-8686
Mailing Address - Fax:
Practice Address - Street 1:443 SHORE ROAD, 2ND FLOOR
Practice Address - Street 2:STE 201
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-407-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT-186936208D00000X
NJMA08383800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60041545OtherHORIZON NJ HEALTH
NJ01004664200OtherAMERICHOICE
P3922128OtherOXFORD
NJ6677002OtherCIGNA
NJ9735178OtherAETNA
NJ0169765Medicaid
NJ131244 PAFMedicare PIN
NJ6677002OtherCIGNA