Provider Demographics
NPI:1508481193
Name:RIVERA, ANDRES FERNANDO (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:FERNANDO
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 1:79-01 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-334-2158
Mailing Address - Fax:716-334-2662
Practice Address - Street 1:79-01 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-334-2158
Practice Address - Fax:716-334-2662
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-03-24
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-03-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program