MEDICARE: MR. RYAN PEPPER NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F407954	NY

General Provider Information

NPI Number	:	1679416234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN PEPPER NP

Provider Business Mailing Address
First Line	:	700 W 172ND ST APT 2F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W 172ND ST APT 2F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1739
Country	:	US
Telephone Number	:	347-952-5606
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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