Healthcare Provider Details

I. General information

NPI: 1790860047
Provider Name (Legal Business Name): CARLOS ENRIQUE RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE MORRISANIA NFHC
BRONX NY
10452-8001
US

IV. Provider business mailing address

29 PORT LN
STATEN ISLAND NY
10302-1154
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2808
  • Fax:
Mailing address:
  • Phone: 718-960-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number161658
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: