Healthcare Provider Details

I. General information

NPI: 1730599754
Provider Name (Legal Business Name): RYAN BARRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TYRELLAN AVE STE 400
STATEN ISLAND NY
10309-2651
US

IV. Provider business mailing address

101 TYRELLAN AVE STE 400
STATEN ISLAND NY
10309-2651
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number290540
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: