Provider Demographics
NPI:1629205547
Name:RIVERA COLIN, RUQAYYAH (PMHNP-BC, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:RUQAYYAH
Middle Name:
Last Name:RIVERA COLIN
Suffix:
Gender:F
Credentials:PMHNP-BC, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MADISON AVE FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2511
Mailing Address - Country:US
Mailing Address - Phone:212-369-6757
Mailing Address - Fax:212-369-3941
Practice Address - Street 1:3901 GENESEE ST STE 110
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1954
Practice Address - Country:US
Practice Address - Phone:716-842-2750
Practice Address - Fax:716-335-7521
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420931363LW0102X
NY403771363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health