Healthcare Provider Details

I. General information

NPI: 1245359769
Provider Name (Legal Business Name): CHRISTINE A RIVAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE RD
STATEN ISLAND NY
10301-3627
US

IV. Provider business mailing address

2791 RICHMOND AVE
STATEN ISLAND NY
10314-5882
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax:
Mailing address:
  • Phone: 718-816-3710
  • Fax: 718-420-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number303979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: