Healthcare Provider Details

I. General information

NPI: 1942036793
Provider Name (Legal Business Name): RIYA JIBI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 HARVEY AVE
STATEN ISLAND NY
10314-2126
US

IV. Provider business mailing address

72 HARVEY AVE
STATEN ISLAND NY
10314-2126
US

V. Phone/Fax

Practice location:
  • Phone: 347-213-4630
  • Fax:
Mailing address:
  • Phone: 347-213-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355106
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: