Healthcare Provider Details

I. General information

NPI: 1992108732
Provider Name (Legal Business Name): BIANCA RIVERA R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SEIGEL CT 2ND FLOOR
BROOKLYN NY
11206-3751
US

IV. Provider business mailing address

2 SEIGEL CT 2ND FLOOR
BROOKLYN NY
11206-3751
US

V. Phone/Fax

Practice location:
  • Phone: 646-853-0687
  • Fax:
Mailing address:
  • Phone: 646-853-0687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number273245744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: