Provider Demographics
NPI:1578931366
Name:RIVERA, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 NORWAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3524
Mailing Address - Country:US
Mailing Address - Phone:845-245-9519
Mailing Address - Fax:
Practice Address - Street 1:60 EAST 42ST
Practice Address - Street 2:
Practice Address - City:NEW YORK NY
Practice Address - State:NY
Practice Address - Zip Code:10165
Practice Address - Country:US
Practice Address - Phone:212-681-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273823-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse