Doctor Name: | OLEG RIVKIN |
NPI Number: | 1164541165 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 009405 |
Business Practice Address: | 680 Kinderkamack Rd Suite 300 Oradell, NJ - 076491600 |
Business Phone Number: | 2017412550 |
Business Fax Number: | 2013427171 |
Mailing Address: | 680 Kinderkamack Rd, Suite 300 ORADELL |
State: | NJ |
Postal Code: | 076491600 |
Phone Number: | 2017412550 |
Fax Number: | 2013427171 |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 12/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 009405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |