Basic Information
| Provider Information | |||||||||
| NPI: | 1134141344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 110B | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109731410 | ||||||||
| FaxNumber: | 6109731449 | ||||||||
| Practice Location | |||||||||
| Address1: | 412 W MONROE ST | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180421717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103300464 | ||||||||
| FaxNumber: | 4844034024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 08/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS008329L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00150116 | 01 | PA | RAILROAD MEDICARE | OTHER | 001516068 | 05 | PA | MEDICAID | 03218901 | 01 | PA | NCAS | OTHER | 2108266 | 01 | PA | AETNA | OTHER | 0686606 | 01 | PA | KEYSTONE CENTRAL | OTHER | 0000686607 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 03218901 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 0791567000 | 01 | PA | PERSONAL CHOICE | OTHER |