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General NPI Number Information
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NPI Number | 1063367274
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Entity Type | Individual
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Provider Name | SIDMAEL BUTLER-RIVERA
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Gender | Male
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/08/2026
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Provider Practice Location Address
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Address Line | 2 JOURNAL SQUARE PLZ FL D1
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City | JERSEY CITY
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State | NJ
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Zip | 07306-4001
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Country | US
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Telephone | 201-366-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 609 PALISADE AVE APT 1
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City | JERSEY CITY
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State | NJ
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Zip | 07307-1023
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Country | US
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Telephone | 787-566-0552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02405000
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License Number State | NJ
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