MEDICARE: ROGER ANTONIO RIVERA MD

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	208000000X	Pediatrics Physician	25MA06723600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538160890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER ANTONIO RIVERA MD

Provider Business Mailing Address
First Line	:	870 PALISADE AVE
Second Line	:	STE 204
City	:	TEANECK
State	:	NJ
Zip	:	07666-3419
Country	:	US
Telephone Number	:	201-928-1093
Fax Number	:	201-928-0842

Provider Business Practice Location Address
First Line	:	810 ABBOTT BLVD
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4151
Country	:	US
Telephone Number	:	201-224-3200
Fax Number	:	201-224-4045

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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Directions to “ ROGER ANTONIO RIVERA MD” Practice Location

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