| Organization Name: | RIVERSIDE MEDICAL GROUP PC |
| NPI Number: | 1558555888 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIO MIGLIETTA (PRESIDENT) |
| Mailing Address: | 725 River Rd Suite 106 Edgewater |
| State: | NJ US |
| Postal Code: | 070201171 |
| Phone Number: | 2019432273 |
| Fax Number: | |
| NPI Enumeration Date: | 08/29/2007 |
| NPI Last Update Date: | 08/29/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MB06920900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |