Provider Demographics
NPI:1174107502
Name:RIVERVIEW MEDICAL CARE CORP
Entity type:Organization
Organization Name:RIVERVIEW MEDICAL CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-241-5856
Mailing Address - Street 1:1767 MORRIS AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3532
Mailing Address - Country:US
Mailing Address - Phone:908-875-5200
Mailing Address - Fax:973-370-4040
Practice Address - Street 1:145 PRESIDENTIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-2173
Practice Address - Country:US
Practice Address - Phone:973-241-5856
Practice Address - Fax:973-370-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care