Provider Demographics
NPI:1548013303
Name:RIPS, AVRAM SAMUEL (MS)
Entity type:Individual
Prefix:
First Name:AVRAM
Middle Name:SAMUEL
Last Name:RIPS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINSTON DR APT 804
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3214
Mailing Address - Country:US
Mailing Address - Phone:973-885-5931
Mailing Address - Fax:
Practice Address - Street 1:90 LA SALLE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4719
Practice Address - Country:US
Practice Address - Phone:212-663-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ$$$$$$$$$252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency