Provider Demographics
NPI:1720381361
Name:RYBAK, PENINA PEARL (MA/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PENINA
Middle Name:PEARL
Last Name:RYBAK
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BAKERTOWN RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950
Mailing Address - Country:US
Mailing Address - Phone:845-782-2300
Mailing Address - Fax:845-782-4716
Practice Address - Street 1:1 DINEV RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-782-7510
Practice Address - Fax:845-782-5849
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY#9076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist