MEDICARE: ORLANDO XAVIER RIVERA PA-C

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	363A00000X	Physician Assistant	035506-01	NY

General Provider Information

NPI Number	:	1497690218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORLANDO XAVIER RIVERA PA-C

Provider Business Mailing Address
First Line	:	556 ONDERDONK AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-2576
Country	:	US
Telephone Number	:	347-235-7232
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 MARCUS GARVEY BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-1114
Country	:	US
Telephone Number	:	718-453-9377
Fax Number	:	718-802-1113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/21/2026

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Directions to “ ORLANDO XAVIER RIVERA PA-C” Practice Location

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