Provider Demographics
NPI:1356784524
Name:RIVOLI, STEPHEN LOUIS (DO, MPH, MA,)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LOUIS
Last Name:RIVOLI
Suffix:
Gender:M
Credentials:DO, MPH, MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W 64TH ST APT 8A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6757
Mailing Address - Country:US
Mailing Address - Phone:617-699-5764
Mailing Address - Fax:
Practice Address - Street 1:35 W 64TH ST APT 8A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6757
Practice Address - Country:US
Practice Address - Phone:617-699-5764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14585207L00000X
NY294206207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program