MEDICARE: YELENA RYBAK CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	SP020907	PA
2	363L00000X	Nurse Practitioner	SP020907	PA

General Provider Information

NPI Number	:	1952943458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA RYBAK CRNP

Provider Business Mailing Address
First Line	:	8012 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2616
Country	:	US
Telephone Number	:	215-516-6830
Fax Number	:	215-333-2748

Provider Business Practice Location Address
First Line	:	8012 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2616
Country	:	US
Telephone Number	:	215-516-6830
Fax Number	:	215-333-2748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	07/29/2022

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