Healthcare Provider Details

I. General information

NPI: 1457770158
Provider Name (Legal Business Name): EFILYN RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

92 DAFFODIL LN
STATEN ISLAND NY
10314-5839
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9360
  • Fax:
Mailing address:
  • Phone: 718-761-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338493-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: