Provider Demographics
NPI:1811059116
Name:RIVERA, JULIE A (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:515 W 59TH ST APT 30N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1031
Mailing Address - Country:US
Mailing Address - Phone:212-523-6152
Mailing Address - Fax:212-523-8187
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:ST.LUKE'S-ROOSEVELT HOSPITAL-AINY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-6152
Practice Address - Fax:212-523-8187
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF380931363LP0200X
NYF303966363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02407918Medicaid