Healthcare Provider Details

I. General information

NPI: 1982536132
Provider Name (Legal Business Name): ADRIANA RIVERA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POMPTON RD
WAYNE NJ
07470-2103
US

IV. Provider business mailing address

28 CAMELOT DR
BUDD LAKE NJ
07828-1432
US

V. Phone/Fax

Practice location:
  • Phone: 862-210-2777
  • Fax:
Mailing address:
  • Phone: 862-210-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15582400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: