Healthcare Provider Details

I. General information

NPI: 1225567258
Provider Name (Legal Business Name): RYAN S AZZAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD
ALBANY NY
12208-1707
US

IV. Provider business mailing address

425 NEW SCOTLAND AVE
ALBANY NY
12208-2726
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-8600
  • Fax: 518-525-6545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116031171
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number334770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: