Healthcare Provider Details

I. General information

NPI: 1346103033
Provider Name (Legal Business Name): DAVID MATTHEW RIVERS CRPA-6816
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4778 BROADWAY # 7B
NEW YORK NY
10034-4916
US

IV. Provider business mailing address

4778 BROADWAY # 7B
NEW YORK NY
10034-4916
US

V. Phone/Fax

Practice location:
  • Phone: 646-359-6512
  • Fax:
Mailing address:
  • Phone: 646-359-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCERPA-6816
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: