Provider Demographics
NPI:1871674044
Name:RYBICKI FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:RYBICKI FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-671-1414
Mailing Address - Street 1:9523 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3801
Mailing Address - Country:US
Mailing Address - Phone:215-671-1414
Mailing Address - Fax:215-671-1440
Practice Address - Street 1:9523 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3801
Practice Address - Country:US
Practice Address - Phone:215-671-1414
Practice Address - Fax:215-671-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006176L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103732Medicare ID - Type Unspecified
PAD98689Medicare UPIN