=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194722694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERVIEW MEDICAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2005
-----------------------------------------------------
Last Update Date | 07/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 HARTFORD DR STE 1
-----------------------------------------------------
City | TINTON FALLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-4945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-741-3600
-----------------------------------------------------
Fax | 732-741-6079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 249
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-0249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-741-3600
-----------------------------------------------------
Fax | 732-741-6079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID I DROUT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-741-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | NONE REQUIRED
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | NONE REQUIRED
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | NON REQUIRED
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------