Healthcare Provider Details

I. General information

NPI: 1982514154
Provider Name (Legal Business Name): CONNOR JAMES GERARD RYAN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MASSACHUSETTS AVE
TROY NY
12180-1621
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-268-5242
  • Fax: 518-268-5480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number360070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: