Healthcare Provider Details

I. General information

NPI: 1992615892
Provider Name (Legal Business Name): JAMES RYAN JARRETT CRPA, NYCPS-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N SALINA ST
SYRACUSE NY
13203-1755
US

IV. Provider business mailing address

630 W ONONDAGA ST APT 12
SYRACUSE NY
13204-3750
US

V. Phone/Fax

Practice location:
  • Phone: 315-471-1564
  • Fax:
Mailing address:
  • Phone: 315-884-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number7061
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: