Healthcare Provider Details

I. General information

NPI: 1912832957
Provider Name (Legal Business Name): REBECCA RIORDAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 WILLOW GROVE ST
HACKETTSTOWN NJ
07840-1799
US

IV. Provider business mailing address

6 CHESTER PL
CHESTER NJ
07930-2839
US

V. Phone/Fax

Practice location:
  • Phone: 908-850-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: