Healthcare Provider Details

I. General information

NPI: 1346789351
Provider Name (Legal Business Name): JEFFREY RYCK CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY MICHAEL RYCK CRNP

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SHIPPERS RD
VESTAL NY
13850-2080
US

IV. Provider business mailing address

215 YORK AVE
TOWANDA PA
18848-1933
US

V. Phone/Fax

Practice location:
  • Phone: 607-250-2180
  • Fax:
Mailing address:
  • Phone: 570-881-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP017224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: