Provider Demographics
NPI:1659751550
Name:RIVERA, STEPHEN (RN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 WESTCHESTER AVE STE N-230
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3522
Mailing Address - Country:US
Mailing Address - Phone:347-558-8456
Mailing Address - Fax:
Practice Address - Street 1:1133 WESTCHESTER AVE STE N-230
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3522
Practice Address - Country:US
Practice Address - Phone:347-558-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320564164W00000X
NY888841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse