Provider Demographics
NPI:1144765850
Name:RYAN, GREGORY P (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:RYAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUNSET LN E
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1644
Mailing Address - Country:US
Mailing Address - Phone:516-965-8792
Mailing Address - Fax:
Practice Address - Street 1:4 SUNSET LN E
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1644
Practice Address - Country:US
Practice Address - Phone:516-965-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist