Healthcare Provider Details

I. General information

NPI: 1427416189
Provider Name (Legal Business Name): PRN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
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

2355 E 12TH ST APT 2G
BROOKLYN NY
11229-4224
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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340277
License Number StateNY

VIII. Authorized Official

Name: DR. YANA RYZHAKOVA
Title or Position: OWNER
Credential:
Phone: 347-450-6040