Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 157585 | NY |
N | 207PE0004X | Emergency Medical Services | 157585 | NY |
Y | 208D00000X | General Practice Physician | 157585 | NY |
NPI | 1205139896 |
---|---|
Provider Name | Luis Rivera |
First Address | New York, NY 10025-6036 |
Second Address | New York, NY 10025-6036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2010 |
Last Update Date | 22/12/2010 |