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General NPI Number Information
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NPI Number | 1811910102
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Entity Type | Organization
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Legal Business Name | RIVERSIDE HOSPITAL INC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 10510 JEFFERSON AVE SUITE E
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-3102
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Country | US
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Telephone | 757-594-2846
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Fax | 757-594-1714
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Provider Business Mailing Address
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Address Line | 856 J CLYDE MORRIS BLVD SUITE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1318
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Country | US
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Telephone | 757-594-4006
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Fax | 757-534-5190
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JAMES LESNICK
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Credential | MD
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Telephone | 757-594-4006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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