Healthcare Provider Details

I. General information

NPI: 1407867724
Provider Name (Legal Business Name): YEKATERINA RYZOVA-VAYSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG 14
STONY BROOK NY
11790-2555
US

IV. Provider business mailing address

2500 NESCONSET HWY BLDG 14
STONY BROOK NY
11790-2555
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-6226
  • Fax: 631-675-0736
Mailing address:
  • Phone: 631-689-6226
  • Fax: 631-675-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number218364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: