Healthcare Provider Details

I. General information

NPI: 1417536129
Provider Name (Legal Business Name): RYAN CASEY MCGOWAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 TAYLORS MILLS RD
MANALAPAN NJ
07726-3229
US

IV. Provider business mailing address

1485 COVENTRY RD
ALLENTOWN PA
18104-2027
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-8787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00389200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: