Healthcare Provider Details

I. General information

NPI: 1124893953
Provider Name (Legal Business Name): DESIREE RIVERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 HIGHLAND AVE STE 2
CHESHIRE CT
06410-2540
US

IV. Provider business mailing address

2626 HALPERIN AVE
BRONX NY
10461-2631
US

V. Phone/Fax

Practice location:
  • Phone: 860-398-9627
  • Fax:
Mailing address:
  • Phone: 718-618-0401
  • Fax: 347-479-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353125
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: