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Individual

DR. JOHN EDWIN RIVERA JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
PO BOX 770, MILLDALE, CT 06467-0770
(860) 621-5554
(860) 621-3833
Mailing address
20 YORK ST, CB-2041, NEW HAVEN, CT 06504-8900
(203) 688-4748
(203) 688-4740

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042567
CT
332B00000X
Durable Medical Equipment & Medical Supplies
042567
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
042567
STATE MEDICAL LICENSE
CT
Enumeration date
04/26/2006
Last updated
03/31/2026
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