Healthcare Provider Details

I. General information

NPI: 1871464719
Provider Name (Legal Business Name): DARLENE RYDBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 EATONDALE AVE
BLUE POINT NY
11715-1022
US

IV. Provider business mailing address

55 EATONDALE AVE
BLUE POINT NY
11715-1022
US

V. Phone/Fax

Practice location:
  • Phone: 631-327-7255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number525960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: