Provider Demographics
NPI:1508959917
Name:RYE BROOK NEUROLOGY, PC
Entity Type:Organization
Organization Name:RYE BROOK NEUROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:AUDRIE
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-255-2333
Mailing Address - Street 1:153 E 87TH ST APT 10B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 QUAKER RIDGE RD
Practice Address - Street 2:STE 207
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2808
Practice Address - Country:US
Practice Address - Phone:917-272-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206602207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30440476OtherMAGNACARE
NY7745380OtherCIGNA
NYDM6602OtherATLANTIS HEALTH PLAN
NY2399196OtherUHC
NY7051585OtherAETNA
NYP3241805OtherOXFORD
NY206602OtherHIP
NY01872586Medicaid
NY4C9461OtherHEALTH NET
NY53N521OtherEMPIRE BCBS
NY030440476DE02OtherCARE PLUS
NY3099038OtherGHI
NYDM6602OtherATLANTIS HEALTH PLAN
NY206602OtherHIP
NY3099038OtherGHI