Provider Demographics
NPI:1376804419
Name:RYBY, DENISE EILEEN
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:EILEEN
Last Name:RYBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3225
Mailing Address - Country:US
Mailing Address - Phone:631-255-0232
Mailing Address - Fax:
Practice Address - Street 1:39 IMPERIAL DR
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3225
Practice Address - Country:US
Practice Address - Phone:631-255-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1222327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist