Healthcare Provider Details

I. General information

NPI: 1891126173
Provider Name (Legal Business Name): MICHELLE RIVERA DEJESUS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MICHELLE DAJAY RIVERA

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 KINDERKAMACK RD STE 2
RIVER EDGE NJ
07661-2307
US

IV. Provider business mailing address

887 KINDERKAMACK RD STE 2
RIVER EDGE NJ
07661-2307
US

V. Phone/Fax

Practice location:
  • Phone: 201-464-0860
  • Fax: 888-440-2752
Mailing address:
  • Phone: 201-464-0860
  • Fax: 888-440-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00460700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: