Individual
DINA MARIE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4199 JERICHO TPKE, EAST NORTHPORT, NY 11731-6240
(631) 238-3066
Mailing address
4199 JERICHO TPKE, EAST NORTHPORT, NY 11731-6240
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
010462
NY
Other
Enumeration date
09/18/2015
Last updated
12/29/2015
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