Provider Demographics
NPI:1861200990
Name:RIVADENEIRA, MATTHEW AARON
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:RIVADENEIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3327
Mailing Address - Country:US
Mailing Address - Phone:516-660-4148
Mailing Address - Fax:
Practice Address - Street 1:28 LYNWOOD DR
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3327
Practice Address - Country:US
Practice Address - Phone:516-660-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program