Healthcare Provider Details

I. General information

NPI: 1194722694
Provider Name (Legal Business Name): RIVERVIEW MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HARTFORD DR STE 1
TINTON FALLS NJ
07701-4945
US

IV. Provider business mailing address

PO BOX 249
RED BANK NJ
07701-0249
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-3600
  • Fax: 732-741-6079
Mailing address:
  • Phone: 732-741-3600
  • Fax: 732-741-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberNONE REQUIRED
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberNONE REQUIRED
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNON REQUIRED
License Number StateNJ

VIII. Authorized Official

Name: DAVID I DROUT
Title or Position: PRESIDENT
Credential: MD
Phone: 732-741-3600