Healthcare Provider Details

I. General information

NPI: 1518292911
Provider Name (Legal Business Name): RYAN PATRICK STEWART RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RIVER AVE
CORNWALL ON HUDSON NY
12520-1121
US

IV. Provider business mailing address

10 RIVER AVE
CORNWALL ON HUDSON NY
12520-1121
US

V. Phone/Fax

Practice location:
  • Phone: 845-527-3644
  • Fax:
Mailing address:
  • Phone: 845-527-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number618769-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: