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General NPI Number Information
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NPI Number | 1295032860
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Entity Type | Individual
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Provider Name | RYAN CONNOR KISSANE PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 1450 CHAPEL ST EMERGENCY DEPARTMENT
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City | NEW HAVEN
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State | CT
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Zip | 06511-4405
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Country | US
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Telephone | 860-817-1860
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Fax |
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Provider Business Mailing Address
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Address Line | 145 BARTLETT DR
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City | MADISON
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State | CT
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Zip | 06443-8201
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Country | US
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Telephone | 860-817-1860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002542
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License Number State | CT
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