Provider Demographics
NPI:1063903920
Name:RILEY, MICHAEL R (MS, CNIM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:RILEY
Suffix:
Gender:M
Credentials:MS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANCIS PL
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1613
Mailing Address - Country:US
Mailing Address - Phone:518-727-2238
Mailing Address - Fax:
Practice Address - Street 1:5 FRANCIS PL
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1613
Practice Address - Country:US
Practice Address - Phone:518-727-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic