Healthcare Provider Details

I. General information

NPI: 1679096663
Provider Name (Legal Business Name): RYAN THACHEN-CARY MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E CHESTNUT ST STE 106
ROME NY
13440-2834
US

IV. Provider business mailing address

PO BOX 2000
EAST SYRACUSE NY
13057-4500
US

V. Phone/Fax

Practice location:
  • Phone: 153-389-2003
  • Fax: 315-338-9202
Mailing address:
  • Phone: 315-362-5129
  • Fax: 315-362-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number313130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: