Provider Demographics
NPI:1578841938
Name:IRINA RYBALOVA PC
Entity Type:Organization
Organization Name:IRINA RYBALOVA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBALOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-378-2843
Mailing Address - Street 1:21 W MERRICK RD
Mailing Address - Street 2:IRINA RYBALOVA PC
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:516-378-2843
Mailing Address - Fax:516-771-8877
Practice Address - Street 1:21 W MERRICK RD
Practice Address - Street 2:IRINA RYBALOVA DDS
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520
Practice Address - Country:US
Practice Address - Phone:516-378-2843
Practice Address - Fax:516-771-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0499011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty