Healthcare Provider Details

I. General information

NPI: 1871711820
Provider Name (Legal Business Name): RAYMOND A. RIVELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLENWOOD PL
PENNSVILLE NJ
08070-0247
US

IV. Provider business mailing address

7 GLENWOOD PL PO BOX 247
PENNSVILLE NJ
08070-1732
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 TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00102000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: