Provider Demographics
NPI:1023670361
Name:RIVERA, JEROME TOLENTINO JR (DPT)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:TOLENTINO
Last Name:RIVERA
Suffix:JR
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 1:3119 33RD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2011
Mailing Address - Country:US
Mailing Address - Phone:859-810-1597
Mailing Address - Fax:
Practice Address - Street 1:3119 33RD ST APT 1
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2011
Practice Address - Country:US
Practice Address - Phone:859-810-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist