Healthcare Provider Details

I. General information

NPI: 1710085121
Provider Name (Legal Business Name): RAYMOND A RIVELL DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLENWOOD PLACE
PENNSVILLE NJ
08070-0247
US

IV. Provider business mailing address

PO BOX 247 7 GLENWOOD PLACE
PENNSVILLE NJ
08070-0247
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-4550
  • Fax: 856-678-6272
Mailing address:
  • Phone: 856-678-4550
  • Fax: 856-678-6272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00102000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number25MD00102000
License Number StateNJ

VIII. Authorized Official

Name: DR. RAYMOND ARTHUR RIVELL
Title or Position: PRESIDENT
Credential: DPM
Phone: 856-678-4550