Healthcare Provider Details

I. General information

NPI: 1336493386
Provider Name (Legal Business Name): SONIA RIVADELO RN MSN ANP-BC CCRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD BERGEN REGIONAL MEDICAL CENTER
PARAMUS NJ
07652
US

IV. Provider business mailing address

136 WILLOW AVE
HACKENSACK NJ
07601-3049
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-4151
  • Fax:
Mailing address:
  • Phone: 201-880-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00393600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: