Provider Demographics
NPI:1720405939
Name:RIVIELLO, HEIDI NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:NICOLE
Last Name:RIVIELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:BRESCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1033 US HIGHWAY 46 STE 102
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2448
Mailing Address - Country:US
Mailing Address - Phone:973-799-7979
Mailing Address - Fax:973-799-7970
Practice Address - Street 1:171 LAKE ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2089
Practice Address - Country:US
Practice Address - Phone:017-850-0112
Practice Address - Fax:201-785-9100
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3159363AM0700X
NJMP00599500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical