Healthcare Provider Details

I. General information

NPI: 1417653601
Provider Name (Legal Business Name): PRISCILLA ANN RIVERA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 PARK AVE FL 2
EAST ORANGE NJ
07017-1905
US

IV. Provider business mailing address

613 PARK AVE FL 2
EAST ORANGE NJ
07017-1905
US

V. Phone/Fax

Practice location:
  • Phone: 973-672-8573
  • Fax: 973-675-0040
Mailing address:
  • Phone: 973-672-8573
  • Fax: 973-675-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ15305500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number798247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: