Healthcare Provider Details

I. General information

NPI: 1093185548
Provider Name (Legal Business Name): RYAN KRUK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 BROWNS HILL RD
PITTSBURGH PA
15217-2917
US

IV. Provider business mailing address

4516 BROWNS HILL RD
PITTSBURGH PA
15217-2917
US

V. Phone/Fax

Practice location:
  • Phone: 412-422-7442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057562
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: