Healthcare Provider Details

I. General information

NPI: 1407281066
Provider Name (Legal Business Name): RYAN PATRICK HUTCHISON L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 BROAD ST
RED BANK NJ
07701-2020
US

IV. Provider business mailing address

111 BUERMANN AVE
TOMS RIVER NJ
08753-8226
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-2944
  • Fax:
Mailing address:
  • Phone: 848-480-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00480100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: