Provider Demographics
NPI:1194722694
Name:RIVERVIEW MEDICAL ASSOCIATES PA
Entity type:Organization
Organization Name:RIVERVIEW MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:DROUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-3600
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0249
Mailing Address - Country:US
Mailing Address - Phone:732-741-3600
Mailing Address - Fax:732-741-6079
Practice Address - Street 1:4 HARTFORD DR STE 1
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4945
Practice Address - Country:US
Practice Address - Phone:732-741-3600
Practice Address - Fax:732-741-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNON REQUIRED207R00000X
NJNONE REQUIRED207RC0000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6440908Medicaid
NJ6440908Medicaid
NJ599075Medicare ID - Type UnspecifiedPRACTICE GROUP MEDICARE