Healthcare Provider Details

I. General information

NPI: 1124277793
Provider Name (Legal Business Name): CARMINA RAMONA NOLASCO RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 HILLSIDE AVE
JAMAICA NY
11432-3216
US

IV. Provider business mailing address

183 109TH AVE
ELMONT NY
11003-2017
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-1111
  • Fax:
Mailing address:
  • Phone: 516-502-6574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number250151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: