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1720405939 NPI number — HEIDI NICOLE RIVIELLO PA-C

NPI Number: 1720405939
Health Care Provider/Practitioner: HEIDI NICOLE RIVIELLO PA-C

Information about “1720405939” NPI (HEIDI NICOLE RIVIELLO PA-C) exists in 1720405939 in HTML format HTML  |  1720405939 in plain Text format TXT  |  1720405939 in PDF (Portable Document Format) PDF  |  1720405939 in an XML format XML  formats.

NPI Number : 1720405939 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720405939",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RIVIELLO",
    "FirstName": "HEIDI",
    "MiddleName": "NICOLE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRESCIA",
    "OtherFirstName": "HEIDI",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1033 US HIGHWAY 46 STE 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLIFTON",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07013-2448",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "973-799-7979",
    "MailingAddressFaxNumber": "973-799-7970",
    "FirstLinePracticeLocationAddress": "171 LAKE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RAMSEY",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07446-2089",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "17-850-0112",
    "PracticeLocationAddressFaxNumber": "201-785-9100",
    "EnumerationDate": "03/25/2014",
    "LastUpdateDate": "05/15/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "3159",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "MP00599500",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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