Healthcare Provider Details

I. General information

NPI: 1629763826
Provider Name (Legal Business Name): RYAN KIRK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LINCOLN HWY STE 500
EDISON NJ
08820-3961
US

IV. Provider business mailing address

2 LINCOLN HWY STE 500
EDISON NJ
08820-3961
US

V. Phone/Fax

Practice location:
  • Phone: 800-843-2384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA13044700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: