Healthcare Provider Details

I. General information

NPI: 1891444360
Provider Name (Legal Business Name): RYAN WILLIAM DUFFY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2273
  • Fax:
Mailing address:
  • Phone: 215-707-5864
  • Fax: 215-707-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP025315
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: