# RIVERSIDE MEDICAL GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053867598
- **Authorized official:** MIRIAM BAKER J.D., M.P.P (EXECUTIVE PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (201) 774-0149

## Contact information

- **Practice address:** 714 10TH ST, SECAUCUS, NJ 07094-2921
- **Practice address phone:** (201) 865-2050
- **Mailing address:** 714 10TH ST, SECAUCUS, NJ 07094-2921
- **Mailing address phone:** (201) 865-2050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 26NJ00655100 | NJ | Yes |

## Other

- **Enumeration date:** 08/25/2016
- **Last updated:** 08/25/2016