Healthcare Provider Details

I. General information

NPI: 1689796781
Provider Name (Legal Business Name): JAMES J RYAN RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 BROADWAY 3RD FLOOR
KINGSTON NY
12401-4626
US

IV. Provider business mailing address

396 BROADWAY 3RD FLOOR
KINGSTON NY
12401-4626
US

V. Phone/Fax

Practice location:
  • Phone: 845-334-2700
  • Fax: 845-334-2898
Mailing address:
  • Phone: 845-334-2700
  • Fax: 845-334-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: