MEDICARE: DR. IRENE M. RYAN

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	111N00000X	Chiropractor	MCO 1914	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0116918000	OTHER	NJ	AMERIHEALTH

General Provider Information

NPI Number	:	1427143528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. IRENE M. RYAN

Provider Business Mailing Address
First Line	:	25 N ALBANY AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-3569
Country	:	US
Telephone Number	:	609-345-3686
Fax Number	:	609-345-3698

Provider Business Practice Location Address
First Line	:	25 N ALBANY AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-3569
Country	:	US
Telephone Number	:	609-345-3686
Fax Number	:	609-345-3698

Authorized Official
Title or Position	:	PHYSICAN
Name	:	DR. IRENE M RYAN
Credential	:	D.C.
Telephone Number	:	609-345-3686

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/25/2008

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