MEDICARE: ALINA RYBERG M.S.CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00589700	NJ

General Provider Information

NPI Number	:	1780045195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALINA RYBERG M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	28 GROVE ST
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5420
Country	:	US
Telephone Number	:	917-685-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 GROVE ST
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5420
Country	:	US
Telephone Number	:	917-685-3607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/11/2016

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