Basic Information
| Provider Information | |||||||||
| NPI: | 1639566003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | COLIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 YORK AVE FL 11 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469622020 | ||||||||
| FaxNumber: | 6469620602 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 YORK AVE FL 11 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469622020 | ||||||||
| FaxNumber: | 6469620602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | 303500 | NY | Y | 193200000X MULTI-SPECIALTY GROUP |
No ID Information.