Riversquare Clinic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

25MZ00088900 Issued in NJ

Legal business name

RIVERSQUARE CLINIC, LLC

Practice address

140 Sylvan Ave
Suite 107
Englewood Cliffs, NJ 07632-2514

Phone

(201) 944-0985

Fax

(201) 944-0912

NPI assigned

Apr 5, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Juseok Park

Title

President

Phone

(201) 944-0985

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1365120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365120000000",
    "number": "1518200773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SYLVAN AVE",
            "address_2": "SUITE 107",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322514",
            "telephone_number": "201-944-0985",
            "fax_number": "201-944-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SYLVAN AVE",
            "address_2": "SUITE 107",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322514",
            "telephone_number": "201-944-0985",
            "fax_number": "201-944-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSQUARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-05",
        "last_updated": "2013-04-05",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JUSEOK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-944-0985",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NJ",
            "license": "25MZ00088900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Englewood Cliffs, NJ
• Providers in Englewood Cliffs, NJ by specialty
• Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2013; 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.