Provider Demographics
NPI:1992157911
Name:RIFKIN, RYAN (NP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:RIFKIN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 8TH AVE # 107
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1607
Mailing Address - Country:US
Mailing Address - Phone:212-234-7926
Mailing Address - Fax:209-265-1063
Practice Address - Street 1:342A W 21ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3303
Practice Address - Country:US
Practice Address - Phone:212-234-7926
Practice Address - Fax:929-483-2987
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-02
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690731163W00000X
NY402296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse