Provider Demographics
NPI:1023127917
Name:RIVERA-COMPETIELLO, NELZA (MD)
Entity type:Individual
Prefix:
First Name:NELZA
Middle Name:
Last Name:RIVERA-COMPETIELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HAZARD AVENUE
Mailing Address - Street 2:BLDG 1 STE 3
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-763-3434
Mailing Address - Fax:860-749-7111
Practice Address - Street 1:139 HAZARD AVENUE
Practice Address - Street 2:BLDG 1 STE 3
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-763-3434
Practice Address - Fax:860-749-7111
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029118208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001291187000OtherBCBS
D37961Medicare UPIN
CT001291187000OtherBCBS