Healthcare Provider Details

I. General information

NPI: 1508558602
Provider Name (Legal Business Name): MARTIN AMANI RYAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N PROVIDENCE RD STE 103
MEDIA PA
19063-3530
US

IV. Provider business mailing address

513 SPRING MEADOW LN
WEBSTER NY
14580-4043
US

V. Phone/Fax

Practice location:
  • Phone: 610-566-4563
  • Fax:
Mailing address:
  • Phone: 585-489-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007381
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: