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General NPI Number Information
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NPI Number | 1720044811
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Entity Type | Individual
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Provider Name | JOHN EDWIN RIVERA JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | PO BOX 770
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City | MILLDALE
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State | CT
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Zip | 06467-0770
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Country | US
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Telephone | 860-621-5554
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Fax | 860-621-3833
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Provider Business Mailing Address
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Address Line | 20 YORK ST CB-2041
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City | NEW HAVEN
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State | CT
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Zip | 06504-8900
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Country | US
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Telephone | 203-688-4748
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Fax | 203-688-4740
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042567
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License Number State | CT
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