Provider Demographics
NPI:1386793651
Name:RYVKIN, IRINA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:RYVKIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 PARK LN S
Mailing Address - Street 2:A5E
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1014
Mailing Address - Country:US
Mailing Address - Phone:718-805-9230
Mailing Address - Fax:
Practice Address - Street 1:11701 PARK LN S
Practice Address - Street 2:A5E
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1014
Practice Address - Country:US
Practice Address - Phone:718-805-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health