Provider Demographics
NPI:1710085121
Name:RAYMOND A RIVELL DPM PA
Entity Type:Organization
Organization Name:RAYMOND A RIVELL DPM PA
Other - Org Name:RAYMOND A RIVELL DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:RIVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-678-4550
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:7 GLENWOOD PLACE
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-0247
Mailing Address - Country:US
Mailing Address - Phone:856-678-4550
Mailing Address - Fax:856-678-6272
Practice Address - Street 1:7 GLENWOOD PLACE
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-0247
Practice Address - Country:US
Practice Address - Phone:856-678-4550
Practice Address - Fax:856-678-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00102000163WW0000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H58955OtherOXFORD HEALTHCARE
NJ3058808Medicaid
2223015000OtherAMERIHEALTH
458955OtherUNITED HEALTHCARE
0083018000OtherAMERIHEALTH
NJ3058808Medicaid
137752Medicare ID - Type Unspecified