Provider Demographics
NPI:1639122716
Name:RIVERA, ALBERTO R (MD,FACEP)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD,FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIPTIDE PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6507
Mailing Address - Country:US
Mailing Address - Phone:386-986-9389
Mailing Address - Fax:
Practice Address - Street 1:651 W MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1600
Practice Address - Country:US
Practice Address - Phone:973-740-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04193300207P00000X
FLME86259207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266783500Medicaid
NJ0695807Medicaid
NJ0695807Medicaid
FL266783500Medicaid
E52536Medicare UPIN
FL62779UMedicare PIN