Healthcare Provider Details

I. General information

NPI: 1710041637
Provider Name (Legal Business Name): JO RIEBEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DELAWARE DR
NEW HYDE PARK NY
11042-1116
US

IV. Provider business mailing address

3 DELAWARE DR
NEW HYDE PARK NY
11042-1116
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-6087
  • Fax: 516-622-6082
Mailing address:
  • Phone: 516-622-6087
  • Fax: 516-622-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number146748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: