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General NPI Number Information
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NPI Number | 1336345313
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Entity Type | Individual
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Provider Name | RYAN HOUSAM MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 3322 ROUTE 22 STE 1002
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City | BRANCHBURG
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State | NJ
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Zip | 08876-4403
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Country | US
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Telephone | 908-725-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 3322 ROUTE 22 STE 1002
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City | BRANCHBURG
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State | NJ
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Zip | 08876-4403
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Country | US
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Telephone | 908-725-5530
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT190141
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD438508
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA09108300
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License Number State | NJ
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