Provider Demographics
NPI:1174622781
Name:RIVERDALE MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:RIVERDALE MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-723-9113
Mailing Address - Street 1:1 CHRISTIE PLACE, #407
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-0000
Mailing Address - Country:US
Mailing Address - Phone:914-723-9113
Mailing Address - Fax:718-601-5642
Practice Address - Street 1:1 CHRISTIE PL # 407
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-8302
Practice Address - Country:US
Practice Address - Phone:914-723-9113
Practice Address - Fax:718-601-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW02291Medicare ID - Type Unspecified