1760684161 NPI number — WITOLD RYBICKI MD

Table of content: WITOLD RYBICKI MD (NPI 1760684161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760684161 NPI number — WITOLD RYBICKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYBICKI
Provider First Name:
WITOLD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760684161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 TWIN LAKE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-829-5566
Provider Business Mailing Address Fax Number:
309-827-3705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 TREMONT
Provider Second Line Business Practice Location Address:
HOPEDALE MEDICAL COMPLEX
Provider Business Practice Location Address City Name:
HOPEDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-449-3321
Provider Business Practice Location Address Fax Number:
309-449-5441
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L82228 . This is a "PIN" identifier . This identifiers is of the category "OTHER".




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