MEDICARE: MRS. ROBIN GAIL RIVERA FNP -BC

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	363LF0000X	Family Nurse Practitioner	F334959	NY

General Provider Information

NPI Number	:	1912938937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBIN GAIL RIVERA FNP -BC

Provider Business Mailing Address
First Line	:	737 CRAFT AVE
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-3210
Country	:	US
Telephone Number	:	516-451-8682
Fax Number	:	718-235-1087

Provider Business Practice Location Address
First Line	:	999 JAMAICA AVE
Second Line	:	FRANKLIN K LANE HS HEALTH CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1503
Country	:	US
Telephone Number	:	718-235-1087
Fax Number	:	718-235-1291

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	05/03/2011

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