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1235545468 NPI number — RYAN JOHN BANGE CRNA

NPI Number: 1235545468
Health Care Provider/Practitioner: RYAN JOHN BANGE CRNA

Information about “1235545468” NPI (RYAN JOHN BANGE CRNA) exists in 1235545468 in HTML format HTML  |  1235545468 in plain Text format TXT  |  1235545468 in PDF (Portable Document Format) PDF  |  1235545468 in an XML format XML  formats.

NPI Number : 1235545468 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235545468",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BANGE",
    "FirstName": "RYAN",
    "MiddleName": "JOHN",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 626",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREAT RIVER",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11739-0626",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "848-448-3305",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "550 1ST AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW YORK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10016-6402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "212-263-7300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/09/2014",
    "LastUpdateDate": "05/12/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "616470",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "616470",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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