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NPI Code Detail

MEDICARE: DR. TIMOTHY J RYAN MD

MEDICARE: DR. TIMOTHY J RYAN MD
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
1207Q00000XFamily Medicine Physician1319051NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356337000
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY J RYAN MD
Provider Business Mailing Address
First Line : 1991 BALSLEY RD
Second Line :
City : SENECA FALLS
State : NY
Zip : 13148-9714
Country : US
Telephone Number : 315-539-0237
Fax Number : 315-539-0940
Provider Business Practice Location Address
First Line : 1991 BALSLEY RD
Second Line :
City : SENECA FALLS
State : NY
Zip : 13148-9714
Country : US
Telephone Number : 315-539-0237
Fax Number : 315-539-0940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 12/05/2007

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