Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 051665 | NY |
Y | 1223E0200X | Endodontist | 051665 | NY |
NPI | 1073730933 |
---|---|
Provider Name | Dr. Peter Rybak |
First Address | Great Neck, NY 11021-2610 |
Second Address | Great Neck, NY 11021-2610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 12/11/2011 |