Provider Demographics
NPI:1992365936
Name:RIVERA, JOMARIE ENID (MD, MSMS)
Entity type:Individual
Prefix:DR
First Name:JOMARIE
Middle Name:ENID
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD, MSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N 2ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3638
Mailing Address - Country:US
Mailing Address - Phone:484-937-1068
Mailing Address - Fax:
Practice Address - Street 1:755 MEMORIAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-847-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
PAMT224624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program