Basic Information
| Provider Information | |||||||||
| NPI: | 1770574246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIBAUDO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | RPA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 OLD COUNTRY RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312984479 | ||||||||
| FaxNumber: | 6315913047 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 WOODVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SHOREHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117861331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319291256 | ||||||||
| FaxNumber: | 6319298313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.