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NPI Code Detail

MEDICARE: RIVERSIDE PHYSICIAN SERVICES INC

MEDICARE: RIVERSIDE PHYSICIAN SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1093731549
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE PHYSICIAN SERVICES INC
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD
Second Line : SUITE A
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number : 757-594-4006
Fax Number : 757-534-5190
Provider Business Practice Location Address
First Line : 250 JOSEPHS DR
Second Line :
City : YORKTOWN
State : VA
Zip : 23693-3405
Country : US
Telephone Number : 757-272-0300
Fax Number : 757-272-1938
Authorized Official
Title or Position : VICE PRESIDENT
Name : JAMES LESNICK
Credential : MD
Telephone Number : 757-594-4006
Provider Enumeration Date : 07/15/2006
Last Update Date : 11/25/2020

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Directions to “RIVERSIDE PHYSICIAN SERVICES INC ” Practice Location

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