Provider Demographics
NPI:1154360592
Name:LARIVIERE, AIMEE (MD)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:390 AMWELL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1225
Practice Address - Country:US
Practice Address - Phone:908-431-3100
Practice Address - Fax:908-431-3101
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0008192Medicaid
NJ099177Medicare PIN