Provider Demographics
NPI:1346789351
Name:RYCK, JEFFREY (CRNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:RYCK
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:MICHAEL
Other - Last Name:RYCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:215 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1933
Mailing Address - Country:US
Mailing Address - Phone:570-881-0202
Mailing Address - Fax:
Practice Address - Street 1:3101 SHIPPERS RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2080
Practice Address - Country:US
Practice Address - Phone:607-250-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017224363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner