Provider Demographics
NPI:1225020340
Name:RYBICKI, JOSEPH M (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:RYBICKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9523 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3801
Mailing Address - Country:US
Mailing Address - Phone:215-671-1414
Mailing Address - Fax:215-671-1440
Practice Address - Street 1:9523 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3801
Practice Address - Country:US
Practice Address - Phone:215-671-1414
Practice Address - Fax:215-671-1440
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006176L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98689Medicare UPIN
PA103732Medicare ID - Type Unspecified