Provider Demographics
NPI:1457956781
Name:EAST RIVER RP HOLDINGS LLC
Entity Type:Organization
Organization Name:EAST RIVER RP HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-830-2314
Mailing Address - Street 1:1348 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2743
Mailing Address - Country:US
Mailing Address - Phone:716-773-7682
Mailing Address - Fax:
Practice Address - Street 1:1348 E RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2743
Practice Address - Country:US
Practice Address - Phone:716-773-7682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568519874OtherINDIVIDUAL NPI
1710035043OtherINDIVIDUAL NPI
1528220860OtherINDIVIDUAL NPI