Provider Demographics
NPI:1952859969
Name:WEISS, RIVKA (FNP)
Entity Type:Individual
Prefix:
First Name:RIVKA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CORPORATE WAY STE 2M
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2027
Mailing Address - Country:US
Mailing Address - Phone:718-362-1403
Mailing Address - Fax:718-362-1651
Practice Address - Street 1:612 CORPORATE WAY STE 2M
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2027
Practice Address - Country:US
Practice Address - Phone:718-362-1403
Practice Address - Fax:718-414-1651
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711391-1163W00000X
NJ26NJ00752100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse