MEDICARE: MRS. JULIA RYDER M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1316283559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA RYDER M.S.

Provider Business Mailing Address
First Line	:	256 OLYMPIA BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 OLYMPIA BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4240
Country	:	US
Telephone Number	:	718-909-7693
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	12/17/2012

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