Healthcare Provider Details

I. General information

NPI: 1194923979
Provider Name (Legal Business Name): MR. RYAN DOUGLAS HURM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SICKLETOWN RD
WEST NYACK NY
10994-2906
US

IV. Provider business mailing address

214 SICKLETOWN RD
WEST NYACK NY
10994-2906
US

V. Phone/Fax

Practice location:
  • Phone: 845-639-6480
  • Fax:
Mailing address:
  • Phone: 845-639-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number018983
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: