Clara M. Rivera Physician PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

161107 Issued in NY

Legal business name

CLARA M. RIVERA PHYSICIAN PC

Practice address

11247 Queens Blvd
Suite 106
Forest Hills, NY 11375-7417

Phone

(718) 261-1759

NPI assigned

Jan 17, 2006

Organization subpart

No

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

Authorized official

Name

Clara M Rivera

Title

Sole Proprieter

Phone

(718) 261-1759

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288569600000",
    "number": "1922088053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11247 QUEENS BLVD",
            "address_2": "SUITE 106",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757417",
            "telephone_number": "718-261-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11247 QUEENS BLVD",
            "address_2": "SUITE 106",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757417",
            "telephone_number": "718-261-1759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARA M. RIVERA PHYSICIAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-17",
        "last_updated": "2010-11-01",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE PROPRIETER",
        "authorized_official_telephone_number": "718-261-1759"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "161107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01055009",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2010; 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.