Provider Demographics
NPI:1265947733
Name:RYNECKI, TODD I (RPH)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:I
Last Name:RYNECKI
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 1:185 OSER AVE
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3710
Mailing Address - Country:US
Mailing Address - Phone:800-854-5729
Mailing Address - Fax:800-654-7515
Practice Address - Street 1:185 OSER AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3710
Practice Address - Country:US
Practice Address - Phone:800-854-5729
Practice Address - Fax:800-654-7515
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742098Medicaid