Provider Demographics
NPI:1982831608
Name:RIVAS, DONI MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:DONI
Middle Name:MARIE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DONI
Other - Middle Name:MARIE
Other - Last Name:SEGERIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4295 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5713
Mailing Address - Country:US
Mailing Address - Phone:516-520-2202
Mailing Address - Fax:
Practice Address - Street 1:4295 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5713
Practice Address - Country:US
Practice Address - Phone:516-520-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274346-115207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine