Provider Demographics
NPI:1184692501
Name:RIBES, SUSAN J (DPM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:RIBES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-0545
Mailing Address - Country:US
Mailing Address - Phone:716-675-5252
Mailing Address - Fax:716-675-9163
Practice Address - Street 1:3085 SOUTHWESTERN BLVD
Practice Address - Street 2:STE 102
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-675-5252
Practice Address - Fax:716-675-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010254101OtherUNIVERA
NY041781OtherPTAN
NY0005041782OtherBCBS
NY01063309Medicaid
NY01063309Medicaid