Provider Demographics
NPI:1295037620
Name:RYBAKOV, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RYBAKOV
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 1:57 SAINT MARKS PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7902
Mailing Address - Country:US
Mailing Address - Phone:212-982-3470
Mailing Address - Fax:212-477-0521
Practice Address - Street 1:57 SAINT MARKS PL
Practice Address - Street 2:UNITAS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-7902
Practice Address - Country:US
Practice Address - Phone:212-982-3470
Practice Address - Fax:212-477-0521
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB088291002084P0804X
NY2653932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry