Healthcare Provider Details

I. General information

NPI: 1750017737
Provider Name (Legal Business Name): RIA VIRAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ROUTE 70 STE 12N
LAKEWOOD NJ
08701-5900
US

IV. Provider business mailing address

1255 ROUTE 70 STE 12N
LAKEWOOD NJ
08701-5900
US

V. Phone/Fax

Practice location:
  • Phone: 732-942-0888
  • Fax: 732-942-1230
Mailing address:
  • Phone: 732-942-0888
  • Fax: 732-942-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number25NJ01324300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: