Provider Demographics
NPI:1780137828
Name:RYBIN, IGOR (LMT)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:RYBIN
Suffix:
Gender:M
Credentials:LMT
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 2520
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3229
Mailing Address - Country:US
Mailing Address - Phone:201-637-1045
Mailing Address - Fax:
Practice Address - Street 1:700 PALISADIUM DR
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3239
Practice Address - Country:US
Practice Address - Phone:201-366-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00995800172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist