Healthcare Provider Details

I. General information

NPI: 1548898083
Provider Name (Legal Business Name): PATRICIA P RIVERA MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GRAND AVE STE 101
ENGLEWOOD NJ
07631-4141
US

IV. Provider business mailing address

187 HIGHWAY 36 STE 230
WEST LONG BRANCH NJ
07764-1306
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-7044
  • Fax:
Mailing address:
  • Phone: 732-702-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA12150500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: