Provider Demographics
NPI:1760552053
Name:RIBEIRO, JOSEPH A (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:RIBEIRO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1805
Mailing Address - Country:US
Mailing Address - Phone:914-963-3346
Mailing Address - Fax:914-963-0362
Practice Address - Street 1:284 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2026
Practice Address - Country:US
Practice Address - Phone:914-963-3346
Practice Address - Fax:914-963-0362
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00525599Medicaid
NY5218400001Medicare ID - Type Unspecified