Healthcare Provider Details

I. General information

NPI: 1528513520
Provider Name (Legal Business Name): RYAN PAYNTER AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LUKE CT
OCEAN VIEW NJ
08230-1620
US

IV. Provider business mailing address

6 LUKE CT
OCEAN VIEW NJ
08230-1620
US

V. Phone/Fax

Practice location:
  • Phone: 609-377-0143
  • Fax:
Mailing address:
  • Phone: 609-377-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ15671800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR13818200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: