Provider Demographics
NPI:1841715182
Name:RILEY, SAMUEL STEVEN
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:STEVEN
Last Name:RILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 MCBRIDE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2743
Mailing Address - Country:US
Mailing Address - Phone:401-595-7368
Mailing Address - Fax:
Practice Address - Street 1:33 PLYMOUTH ST STE 102
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2677
Practice Address - Country:US
Practice Address - Phone:973-783-0444
Practice Address - Fax:973-783-4428
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00746400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor