Healthcare Provider Details

I. General information

NPI: 1548298268
Provider Name (Legal Business Name): JOHN J. RYAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARNIE BLVD
VOORHEES NJ
08043-1548
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-5060
  • Fax: 856-325-3197
Mailing address:
  • Phone: 856-686-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00055000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: