Healthcare Provider Details

I. General information

NPI: 1245202662
Provider Name (Legal Business Name): DR. KENNETH RIVLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS 3959 BROADWAY
NEW YORK NY
10032
US

IV. Provider business mailing address

500 E 77TH ST
NEW YORK NY
10162-0010
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7297
  • Fax: 212-544-1974
Mailing address:
  • Phone: 212-304-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number190781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: