Healthcare Provider Details

I. General information

NPI: 1033576863
Provider Name (Legal Business Name): YANA RYZHAKOVA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 NOSTRAND AVE STE 1M
BROOKLYN NY
11235-2250
US

IV. Provider business mailing address

4207 ATLANTIC AVE # 1B
BROOKLYN NY
11224-1023
US

V. Phone/Fax

Practice location:
  • Phone: 347-450-6040
  • Fax: 201-221-8073
Mailing address:
  • Phone: 646-696-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number340277
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number340277
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340277
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number340277
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number340277
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number340277
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: