NPIMap

Organization Active NPI

Riverside Medical Group

  • Nurse Practitioner
  • Secaucus, NJ
National Provider Identifier
1053867598
Registry record updated Aug 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
26NJ00655100 Issued in NJ
Legal business name
RIVERSIDE MEDICAL GROUP
Practice address
714 10TH St
Secaucus, NJ 07094-2921
Phone
(201) 865-2050
NPI assigned
Aug 25, 2016
Last updated
Aug 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miriam Baker, J.D., M.P.P
Title
Executive Practice Administrator
Phone
(201) 774-0149

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ00655100 NJ Primary

Addresses

Primary practice location

714 10TH St
Secaucus, NJ 07094-2921

Mailing address

714 10TH St
Secaucus, NJ 07094-2921
Phone (201) 865-2050

National Provider Directory

National Provider Directory
Tax ID family
Riverside Pediatric Group PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

714 10th St
Secaucus, NJ 07094
Phone (201) 863-3346

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 81

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472083200000",
    "number": "1053867598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 10TH ST",
            "city": "SECAUCUS",
            "state": "NJ",
            "postal_code": "070942921",
            "telephone_number": "201-865-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 10TH ST",
            "city": "SECAUCUS",
            "state": "NJ",
            "postal_code": "070942921",
            "telephone_number": "201-865-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-25",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_title_or_position": "EXECUTIVE PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "201-774-0149",
        "authorized_official_credential": "J.D., M.P.P"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ00655100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Secaucus, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.