Provider Demographics
NPI:1750802518
Name:RIVERA, NELSI
Entity type:Individual
Prefix:
First Name:NELSI
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 REUNION RDG
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9393
Mailing Address - Country:US
Mailing Address - Phone:917-455-3042
Mailing Address - Fax:
Practice Address - Street 1:152-53RD 10TH AVE
Practice Address - Street 2:201
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1135
Practice Address - Country:US
Practice Address - Phone:718-357-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency