MEDICARE: MR. RYAN WHITCOMB RD

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	133V00000X	Registered Dietitian	1073431

General Provider Information

NPI Number	:	1922484492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN WHITCOMB RD

Provider Business Mailing Address
First Line	:	123 TOWN SQUARE PL STE 517
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1756
Country	:	US
Telephone Number	:	201-335-0520
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 TOWN SQUARE PL STE 517
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1756
Country	:	US
Telephone Number	:	866-321-2035
Fax Number	:	888-506-7860

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

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	05/07/2018

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