MEDICARE: ALL MEDICAL RIVERDALE SERVICES PC

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
1	261QP2300X	Primary Care Clinic/Center	210590	NY

General Provider Information

NPI Number	:	1174822589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL MEDICAL RIVERDALE SERVICES PC

Provider Business Mailing Address
First Line	:	3533 RIVERDALE AVE
Second Line	:	STE A
City	:	BRONX
State	:	NY
Zip	:	10463
Country	:	US
Telephone Number	:	718-884-8248
Fax Number	:

Provider Business Practice Location Address
First Line	:	3533 RIVERDALE AVENUE
Second Line	:	STE A
City	:	BRONX
State	:	NY
Zip	:	10463
Country	:	US
Telephone Number	:	718-884-8248
Fax Number	:	888-543-7447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VLADIMIR MOLIVER
Credential	:	MD
Telephone Number	:	718-884-8248

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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