Provider Demographics
NPI:1982014833
Name:RIVOLTA, JUAN ANGEL LEONIDAS (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANGEL LEONIDAS
Last Name:RIVOLTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:38 HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3249
Mailing Address - Country:US
Mailing Address - Phone:917-685-2419
Mailing Address - Fax:917-905-1993
Practice Address - Street 1:411 THEODORE FREMD AVE
Practice Address - Street 2:SUITE 206 SOUTH
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1411
Practice Address - Country:US
Practice Address - Phone:917-685-2419
Practice Address - Fax:917-905-1993
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2025-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2922972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1982014833Medicaid
NY292297OtherNYS LICENSE