Provider Demographics
NPI:1043347537
Name:RIVAS, JAIME (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:60 STRAWBERRY HILL AVE STE L1
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8504
Mailing Address - Country:US
Mailing Address - Phone:203-274-6843
Mailing Address - Fax:888-571-3180
Practice Address - Street 1:60 STRAWBERRY HILL AVE STE L1
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8504
Practice Address - Country:US
Practice Address - Phone:203-274-6843
Practice Address - Fax:888-571-3180
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine