MEDICARE: DR. ELIZABETH RYAN PHD

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	103G00000X	Clinical Neuropsychologist	013982	NY

General Provider Information

NPI Number	:	1043357593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH RYAN PHD

Provider Business Mailing Address
First Line	:	641 LEXINGTON AVE FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4503
Country	:	US
Telephone Number	:	646-888-0044
Fax Number	:	212-888-2384

Provider Business Practice Location Address
First Line	:	641 LEXINGTON AVE FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4503
Country	:	US
Telephone Number	:	646-888-0044
Fax Number	:	212-888-2384

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	11/25/2019

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