Healthcare Provider Details

I. General information

NPI: 1093695132
Provider Name (Legal Business Name): JOSHUA MICHAEL RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

184 KENT AVE APT A312
BROOKLYN NY
11249-3178
US

V. Phone/Fax

Practice location:
  • Phone: 646-929-7800
  • Fax:
Mailing address:
  • Phone: 718-908-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number712848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: