Provider Demographics
NPI:1891121034
Name:RIVERA, RENE ANTONIO (DPT)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ANTONIO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3933
Mailing Address - Country:US
Mailing Address - Phone:914-315-1800
Mailing Address - Fax:914-315-1799
Practice Address - Street 1:1221 AVENUE OF THE AMERICAS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1001
Practice Address - Country:US
Practice Address - Phone:646-562-0617
Practice Address - Fax:212-302-1106
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist