Provider Demographics
NPI:1689089880
Name:RYBALNIKOVA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RYBALNIKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:RUBALNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1347 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5901
Mailing Address - Country:US
Mailing Address - Phone:917-939-7801
Mailing Address - Fax:
Practice Address - Street 1:1347 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5901
Practice Address - Country:US
Practice Address - Phone:917-939-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency