Provider Demographics
NPI:1043769052
Name:RIPPENBAUM, STEFANIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:
Last Name:RIPPENBAUM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HUMBOLDT ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3601
Mailing Address - Country:US
Mailing Address - Phone:267-688-7794
Mailing Address - Fax:
Practice Address - Street 1:580 BROADWAY
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3223
Practice Address - Country:US
Practice Address - Phone:646-918-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721600-1163W00000X
NY309859363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse