Provider Demographics
NPI:1003015785
Name:ROGERS, RYAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7369
Mailing Address - Country:US
Mailing Address - Phone:212-832-9228
Mailing Address - Fax:
Practice Address - Street 1:550 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7369
Practice Address - Country:US
Practice Address - Phone:212-832-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231545-01207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188836403OtherMEDICAID/EAST
TX188836401Medicaid
TX8J8524OtherMEDICARE/EAST
TX8J8523OtherMEDICARE/MP1