Provider Demographics
NPI: | 1851000749 |
---|---|
Name: | RIDGEBURY FARM AND STABLES |
Entity Type: | Organization |
Organization Name: | RIDGEBURY FARM AND STABLES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIMBERLY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RIFFLARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 203-856-0904 |
Mailing Address - Street 1: | 484 RIDGEBURY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | RIDGEFIELD |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06877-1228 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-856-0904 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 484 RIDGEBURY RD |
Practice Address - Street 2: | |
Practice Address - City: | RIDGEFIELD |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06877-1228 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-801-5254 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-11-18 |
Last Update Date: | 2022-11-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
No | 2084P0005X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurodevelopmental Disabilities | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |