Provider Demographics
NPI:1992083224
Name:RIBIAT-REISS, ADEENA (PTA)
Entity type:Individual
Prefix:
First Name:ADEENA
Middle Name:
Last Name:RIBIAT-REISS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MARINER WAY
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 ROBERT PITT DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3373
Practice Address - Country:US
Practice Address - Phone:845-517-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007700-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant