Healthcare Provider Details

I. General information

NPI: 1932025236
Provider Name (Legal Business Name): IVAN JOSE DE JESUS RIJO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 UNIVERSITY AVE
BRONX NY
10453-6914
US

IV. Provider business mailing address

1715 UNIVERSITY AVE
BRONX NY
10453-6914
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-0700
  • Fax: 718-901-1150
Mailing address:
  • Phone: 718-294-0700
  • Fax: 718-901-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP033942
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358220-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: