Provider Demographics
NPI:1043761570
Name:RYAN, GERARD
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD COUNTRY RD
Mailing Address - Street 2:SUITE # 315
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1901
Mailing Address - Country:US
Mailing Address - Phone:516-280-7285
Mailing Address - Fax:516-280-7286
Practice Address - Street 1:500 OLD COUNTRY RD
Practice Address - Street 2:SUITE # 315
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1901
Practice Address - Country:US
Practice Address - Phone:516-280-7285
Practice Address - Fax:516-280-7286
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC 29296101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor