Healthcare Provider Details

I. General information

NPI: 1740964246
Provider Name (Legal Business Name): RIVERVIEW MEDICAL CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PRESIDENTIAL BLVD STE 100
PATERSON NJ
07522-2173
US

IV. Provider business mailing address

1767 MORRIS AVE FL 3
UNION NJ
07083-3532
US

V. Phone/Fax

Practice location:
  • Phone: 973-241-5856
  • Fax:
Mailing address:
  • Phone: 908-875-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNY SMITH
Title or Position: OFFICER
Credential:
Phone: 908-875-5200