Provider Demographics
NPI:1063799021
Name:RIVERA, GLORIA MARIA (BS)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:MARIA AMNA RASHID
Other - Last Name:GHANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:1 SHELART ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1420
Mailing Address - Country:US
Mailing Address - Phone:516-349-3091
Mailing Address - Fax:
Practice Address - Street 1:1 CARMANS RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1438
Practice Address - Country:US
Practice Address - Phone:516-608-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005978-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics