Provider Demographics
NPI:1861099145
Name:RIVERA, NATHALIE JAQUELINE (PA-C)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:JAQUELINE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 RAMAPO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2817
Mailing Address - Country:US
Mailing Address - Phone:201-463-4491
Mailing Address - Fax:
Practice Address - Street 1:225 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3625
Practice Address - Country:US
Practice Address - Phone:908-994-5000
Practice Address - Fax:732-923-2272
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025675-01363A00000X
NJ25MP00584800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant