Provider Demographics
NPI:1841299005
Name:RIVERA, RAMON E (MD)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 ROUTE 59 STE A2
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5013
Mailing Address - Country:US
Mailing Address - Phone:845-517-2870
Mailing Address - Fax:845-517-2871
Practice Address - Street 1:156 ROUTE 59 STE A2
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5013
Practice Address - Country:US
Practice Address - Phone:845-517-2870
Practice Address - Fax:845-517-2871
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232695208600000X
NY232695-12086S0127X, 2086S0102X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02601545Medicaid
NY3584H1Medicare ID - Type Unspecified
NY02601545Medicaid