MEDICARE: DR. RYAN MCCLOSKEY D.O.

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	207P00000X	Emergency Medicine Physician	25MB09875900	NJ

General Provider Information

NPI Number	:	1467715417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MCCLOSKEY D.O.

Provider Business Mailing Address
First Line	:	420 PASSAIC ST
Second Line	:	APARTMENT 4C
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-1571
Country	:	US
Telephone Number	:	585-278-3724
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 ROUTE 33
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-4859
Country	:	US
Telephone Number	:	732-776-4203
Fax Number	:

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

Provider Enumeration Date	:	06/23/2012
Last Update Date	:	08/05/2016

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