Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Domingo A Rivera-Lake, PA

Individual provider Physician Assistant · NPI 1225165319

Domingo A Rivera-Lake, PA is a Physician Assistant in Bronx, New York. Licensed in New York. Registered with an NPI since 2007.

Licensed in
NY
In the registry since
2007
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

111 E 210th St Mmc - Dept OF Radiology
Bronx, NY 10467-2401
Phone: (866) 662-9729
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 009922 (NY)

Record details

NPI number1225165319
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 27, 2007
Last updated in NPPESJuly 8, 2007

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