Healthcare Provider Details

I. General information

NPI: 1215973979
Provider Name (Legal Business Name): WENDY RIVERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 E BROAD ST
WESTFIELD NJ
07090-4204
US

IV. Provider business mailing address

532 E BROAD ST
WESTFIELD NJ
07090-2116
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-3445
  • Fax:
Mailing address:
  • Phone: 908-232-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA06855200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: