Provider Demographics
NPI:1134237282
Name:RIBAUDO, THOMAS P (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:RIBAUDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 RESEARCH WAY
Mailing Address - Street 2:SUITE 008 & 108
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-941-2704
Mailing Address - Fax:631-350-7200
Practice Address - Street 1:45 RESEARCH WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6401
Practice Address - Country:US
Practice Address - Phone:631-941-2704
Practice Address - Fax:631-941-2009
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY139063-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYO8120600Medicaid
NY94A291Medicare PIN
NYB20253Medicare UPIN
NYO8120600Medicaid