Healthcare Provider Details

I. General information

NPI: 1992908263
Provider Name (Legal Business Name): RIVERFRONT MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD SUITE 106
EDGEWATER NJ
07020-1171
US

IV. Provider business mailing address

725 RIVER RD EDGEWATER PLAZA, SUITE 106
EDGEWATER NJ
07020-1171
US

V. Phone/Fax

Practice location:
  • Phone: 201-943-2273
  • Fax: 201-215-9548
Mailing address:
  • Phone: 201-943-2273
  • Fax: 201-215-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB06920900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number227852
License Number StateNY

VIII. Authorized Official

Name: MS. DEBORAH YANNETTE
Title or Position: ADMINISTRATOR
Credential: CPC, CMRS
Phone: 201-837-8693