Provider Demographics
NPI:1861136186
Name:RIVERA, NIKOLAS W (PA)
Entity type:Individual
Prefix:MR
First Name:NIKOLAS
Middle Name:W
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:391 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7137
Mailing Address - Country:US
Mailing Address - Phone:716-998-6810
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:585-922-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant