Healthcare Provider Details

I. General information

NPI: 1053995704
Provider Name (Legal Business Name): JUSTIN RYAN FRANCIS DMH, MA, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD BLDG 8
LYONS NJ
07939-5001
US

IV. Provider business mailing address

151 KNOLLCROFT RD BLDG 8
LYONS NJ
07939-5001
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5268
Mailing address:
  • Phone: 908-647-0180
  • Fax: 908-604-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09529
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: