Provider Demographics
NPI:1427416189
Name:PRN PC
Entity Type:Organization
Organization Name:PRN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYZHAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-696-1150
Mailing Address - Street 1:2355 E 12TH ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4224
Mailing Address - Country:US
Mailing Address - Phone:646-696-1150
Mailing Address - Fax:
Practice Address - Street 1:2355 E 12TH ST APT 2G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4224
Practice Address - Country:US
Practice Address - Phone:646-696-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty