Provider Demographics
NPI:1558417758
Name:RIVERA, DAVID (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:108 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1305
Mailing Address - Country:US
Mailing Address - Phone:845-786-2622
Mailing Address - Fax:
Practice Address - Street 1:3485 E TREMONT AVE STE 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2016
Practice Address - Country:US
Practice Address - Phone:718-828-1549
Practice Address - Fax:718-828-5029
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005652-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical