Provider Demographics
NPI:1992908263
Name:RIVERFRONT MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:RIVERFRONT MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:YANNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CMRS
Authorized Official - Phone:201-837-8693
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:EDGEWATER PLAZA, SUITE 106
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:201-943-2273
Mailing Address - Fax:201-215-9548
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:201-943-2273
Practice Address - Fax:201-215-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06920900207P00000X
NY2278522084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty