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General NPI Number Information
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NPI Number | 1720775620
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Entity Type | Individual
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Provider Name | RYAN SGROI PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 201 STATE RT 17 FL 1202
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City | RUTHERFORD
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State | NJ
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Zip | 07070-2901
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Country | US
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Telephone | 201-975-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 108 IRVING ST APT 1
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City | JERSEY CITY
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State | NJ
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Zip | 07307-3329
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Country | US
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Telephone | 315-264-4299
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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 |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00828400
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License Number State | NJ
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