MEDICARE: THERESA RYAN M.D.

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	207RH0003X	Hematology & Oncology Physician	213963	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598766503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA RYAN M.D.

Provider Business Mailing Address
First Line	:	160 E 34TH ST
Second Line	:	9TH FL.
City	:	NEW YORK
State	:	NY
Zip	:	10016-4750
Country	:	US
Telephone Number	:	212-731-5430
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 E 34TH ST
Second Line	:	9TH FL.
City	:	NEW YORK
State	:	NY
Zip	:	10016-4750
Country	:	US
Telephone Number	:	212-731-5430
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/08/2007

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