Provider Demographics
NPI:1518628114
Name:RIBEIRO, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:RIBEIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2263
Mailing Address - Country:US
Mailing Address - Phone:732-955-0655
Mailing Address - Fax:732-955-0656
Practice Address - Street 1:40 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2263
Practice Address - Country:US
Practice Address - Phone:732-955-0655
Practice Address - Fax:732-955-0656
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02066700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty