Provider Demographics
NPI:1427416189
Name:PRN PC
Entity type:Organization
Organization Name:PRN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYZHAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-450-6040
Mailing Address - Street 1:2355 E 12TH ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4224
Mailing Address - Country:US
Mailing Address - Phone:646-696-1150
Mailing Address - Fax:
Practice Address - Street 1:4050 NOSTRAND AVE STE 1M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2250
Practice Address - Country:US
Practice Address - Phone:347-450-6040
Practice Address - Fax:201-221-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QP2300X
NY340277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care