Provider Demographics
NPI:1841567492
Name:RIVERA, LEONARDO RAMOS JR (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:RAMOS
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 INDUSTRIAL RD
Mailing Address - Street 2:STE 107
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-8626
Mailing Address - Country:US
Mailing Address - Phone:717-759-5148
Mailing Address - Fax:717-759-5435
Practice Address - Street 1:18730 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3216
Practice Address - Country:US
Practice Address - Phone:718-264-1111
Practice Address - Fax:718-264-2195
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264995208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice