Healthcare Provider Details

I. General information

NPI: 1467831230
Provider Name (Legal Business Name): RYAN CASTER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

1850 BRIGHTON HENRIETTA TOWN LINE RD
ROCHESTER NY
14623-2532
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-3846
  • Fax: 585-922-2951
Mailing address:
  • Phone: 585-336-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: