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RIVERDEL MEDICAL PRACTICE, PC
NPI 1487693164
Clinic/Center - Primary Care in Riverside, NJ

Active since June 06, 2006CLIA 31D1018653 · Waiver
302 CLAY ST., RIVERSIDE, NJ 08075(856) 461-7755(856) 461-2699 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Riverdel Medical Practice, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RIVERDEL MEDICAL PRACTICE, PC (NPI 1487693164) is a healthcare organization registered as a primary care in Riverside, New Jersey and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through October 27, 2027 and lists Evacueto P. Tangco, Owner, as its authorized official.

NPPES Registry Identity

NPI1487693164
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameRIVERDEL MEDICAL PRACTICE, PC
Location Address302 CLAY ST.Riverside, NJ 08075
Mailing Address302 Clay St.Riverside, NJ 08075 · (856) 461-7755 · Fax (856) 461-2699
Phone(856) 461-7755
Fax(856) 461-2699
Organization SubpartNo
Authorized OfficialEvacueto P. TangcoOwner · (856) 461-7755
Enumeration DateJune 6, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1487693164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in NJ · 25MA03673200
302 CLAY ST., Riverside, NJ 08075
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D1018653

Riverdel Medical Practice PC · Riverside, NJ
Active · expires Oct 27, 2027
CLIA Number31D1018653
Laboratory TypePhysician Office
Certificate Effective DateOctober 28, 2025
Certificate Expiration DateOctober 27, 2027
Laboratory DirectorEvacueto D. Tango MD
Laboratory Phone(856) 461-7955
Laboratory LocationRiverdel Medical Practice PC302 Clay Street, Riverside, NJ 08075
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Riverdel Medical Practice, PC's NPI number?

The NPI number for Riverdel Medical Practice, PC is 1487693164. It was assigned to this organization in the NPPES registry on June 6, 2006.

Where is Riverdel Medical Practice, PC located?

Riverdel Medical Practice, PC is located at 302 Clay St., Riverside, NJ 08075. The listed phone number is (856) 461-7755.

What is Riverdel Medical Practice, PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Riverdel Medical Practice, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D1018653) is associated with this NPI, valid through October 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Riverdel Medical Practice, PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.