Individual
MR. JOHNNY JOSEPH RIVERA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 ELLSWORTH AVE, BRONX, NY 10465-1755
(646) 963-2013
Mailing address
520 ELLSWORTH AVE, BRONX, NY 10465-1755
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251B00000X
Case Management Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
09/05/2023
Last updated
09/06/2023
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