Healthcare Provider Details

I. General information

NPI: 1497365068
Provider Name (Legal Business Name): RONEL RIVKIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 BROADWAY
LONG ISLAND CITY NY
11106-4532
US

IV. Provider business mailing address

2125 BROADWAY
LONG ISLAND CITY NY
11106-4532
US

V. Phone/Fax

Practice location:
  • Phone: 718-717-3000
  • Fax: 718-691-6835
Mailing address:
  • Phone: 718-717-3000
  • Fax: 718-691-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: