Healthcare Provider Details

I. General information

NPI: 1841299005
Provider Name (Legal Business Name): RAMON E. RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 ROUTE 59 STE A2
SUFFERN NY
10901-5013
US

IV. Provider business mailing address

156 ROUTE 59 STE A2
SUFFERN NY
10901-5013
US

V. Phone/Fax

Practice location:
  • Phone: 845-517-2870
  • Fax: 845-517-2871
Mailing address:
  • Phone: 845-517-2870
  • Fax: 845-517-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number232695
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number232695-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number232695-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number232695-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: