Provider Demographics
NPI:1275896508
Name:RYBITSKIY, DMITRIY (DO)
Entity Type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:RYBITSKIY
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 1:173 MINEOLA BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2555
Mailing Address - Country:US
Mailing Address - Phone:516-663-1145
Mailing Address - Fax:516-663-1874
Practice Address - Street 1:173 MINEOLA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2555
Practice Address - Country:US
Practice Address - Phone:516-663-1145
Practice Address - Fax:516-663-1874
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00624372086S0129X
NY3235492086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery