MEDICARE: MRS. ISAMAR MILAGROS RIVERA M.A. CCC-SLP, TSSLD

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	235Z00000X	Speech-Language Pathologist	027279	NY

General Provider Information

NPI Number	:	1700333994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ISAMAR MILAGROS RIVERA M.A. CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	116 W 238TH ST APT 6G
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4221
Country	:	US
Telephone Number	:	646-496-3596
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3913
Country	:	US
Telephone Number	:	212-927-0607
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	03/17/2018

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