Basic Information
Provider Information
NPI: 1225274863
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIVERA
FirstName: VERONICA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 28082
Address2:  
City: NEW YORK
State: NY
PostalCode: 100878082
CountryCode: US
TelephoneNumber: 2129873100
FaxNumber: 2127315210
Practice Location
Address1: 1440 MADISON AVENUE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100296500
CountryCode: US
TelephoneNumber: 2126598552
FaxNumber: 2124260349
Other Information
ProviderEnumerationDate: 01/04/2009
LastUpdateDate: 10/28/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QG0300X267034NYY Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
207Q00000XA106319CAN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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