Provider Demographics
NPI:1457370785
Name:RIVADENEIRA, DAVID E (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:RIVADENEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:321B CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2066
Mailing Address - Country:US
Mailing Address - Phone:631-470-1450
Mailing Address - Fax:631-470-1451
Practice Address - Street 1:321B CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:631-470-1450
Practice Address - Fax:631-470-1451
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY212811208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02470919Medicaid
NY1636H1OtherEMPIRE BC.BS
NY7019470OtherAETNA
NY7019470OtherAETNA