Healthcare Provider Details

I. General information

NPI: 1831401850
Provider Name (Legal Business Name): RIVER VIEW PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W 1ST ST S
FULTON NY
13069-5050
US

IV. Provider business mailing address

909 W 1ST ST S
FULTON NY
13069-5050
US

V. Phone/Fax

Practice location:
  • Phone: 315-529-4987
  • Fax: 315-592-3571
Mailing address:
  • Phone: 315-529-4987
  • Fax: 315-592-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number275132
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number277792
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number283995
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number249530
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04153068
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier04427125
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier03236775
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 4
Identifier03921675
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: SARAH FINOCCHIARO
Title or Position: PRESIDENT
Credential: MD
Phone: 315-598-6785