Provider Demographics
NPI:1366900748
Name:RILEY, THOMAS JUDE JR (NP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JUDE
Last Name:RILEY
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HDSN VLY PROF PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3150
Mailing Address - Country:US
Mailing Address - Phone:845-575-4775
Mailing Address - Fax:
Practice Address - Street 1:5 HDSN VLY PROF PLZ
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3150
Practice Address - Country:US
Practice Address - Phone:845-595-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382056-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF382056-1OtherNURSE PRACTITIONER
NY470157-1OtherREGISTERED PROFESSIONAL NURSE