Healthcare Provider Details

I. General information

NPI: 1376934224
Provider Name (Legal Business Name): RIVERDALE MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RIVERDALE AVE
PORT CHESTER NY
10573-2737
US

IV. Provider business mailing address

115 E PUTNAM AVE
GREENWICH CT
06830-5643
US

V. Phone/Fax

Practice location:
  • Phone: 203-554-8166
  • Fax:
Mailing address:
  • Phone: 203-554-8166
  • Fax: 888-397-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number246366
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number246366
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246366
License Number StateNY

VIII. Authorized Official

Name: DR. STEVEN MURPHY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-554-8166