Provider Demographics
NPI:1174315378
Name:RIBISI, JASON (MPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RIBISI
Suffix:
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 N RAILROAD AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2348
Mailing Address - Country:US
Mailing Address - Phone:917-312-4804
Mailing Address - Fax:
Practice Address - Street 1:7105 3RD AVE STE 423
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1308
Practice Address - Country:US
Practice Address - Phone:917-312-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral