Provider Demographics
NPI:1912201294
Name:RILEY, ERIN (PA-C, RD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 ROUTE 34 BLDG A5
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1500
Mailing Address - Country:US
Mailing Address - Phone:732-528-5533
Mailing Address - Fax:732-528-0360
Practice Address - Street 1:2399 ROUTE 34 BLDG A5
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1500
Practice Address - Country:US
Practice Address - Phone:732-528-5533
Practice Address - Fax:732-528-0360
Is Sole Proprietor?:No
Enumeration Date:2010-12-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1036251133V00000X
NJ1036251133V00000X
NJ25MP00790900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered