Provider Demographics
NPI:1669781290
Name:RIVARD, MICHELE (PA)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:RIVARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2317
Mailing Address - Country:US
Mailing Address - Phone:212-925-9500
Mailing Address - Fax:212-925-9501
Practice Address - Street 1:114 HUDSON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2317
Practice Address - Country:US
Practice Address - Phone:212-925-9500
Practice Address - Fax:212-925-9501
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant