Healthcare Provider Details

I. General information

NPI: 1598468613
Provider Name (Legal Business Name): DR. DOLLY BASALDUA-RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9226 KENNEDY BLVD STE C
NORTH BERGEN NJ
07047-6585
US

IV. Provider business mailing address

9226 KENNEDY BLVD STE C
NORTH BERGEN NJ
07047-6585
US

V. Phone/Fax

Practice location:
  • Phone: 201-863-3055
  • Fax:
Mailing address:
  • Phone: 201-863-3055
  • Fax: 201-863-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00392600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00392600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: