Provider Demographics
NPI:1245291483
Name:RIVERVIEW UROLOGIC ASSOCIATES
Entity type:Organization
Organization Name:RIVERVIEW UROLOGIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:RITTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-288-3601
Mailing Address - Street 1:423 3RD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5809
Mailing Address - Country:US
Mailing Address - Phone:570-288-3601
Mailing Address - Fax:570-288-1726
Practice Address - Street 1:423 3RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5809
Practice Address - Country:US
Practice Address - Phone:570-288-3601
Practice Address - Fax:570-288-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA31950OtherHEALTH AMERICA
NY1000828OtherGHI
DC02312200OtherCAPITAL BLUE CROSS
PA0006718740002Medicaid
PA1039517OtherKEYSTONE MERCY
PA505911OtherAETNA USHEALTHCARE
PA0900660001OtherMEDICARE DME
PA034369OtherBLUE SHIELD
PA0671874OtherGATEWAY HEALTH PLAN
PA811056OtherFIRST PRIORITY HEALTH
PACA9999OtherTRAVELERS RAILROAD MEDICA
PA31950OtherHEALTH AMERICA