Healthcare Provider Details

I. General information

NPI: 1679416234
Provider Name (Legal Business Name): RYAN PEPPER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 172ND ST APT 2F
NEW YORK NY
10032-1739
US

IV. Provider business mailing address

700 W 172ND ST APT 2F
NEW YORK NY
10032-1739
US

V. Phone/Fax

Practice location:
  • Phone: 347-952-5606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF407954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: