Provider Demographics
NPI:1164428728
Name:RYS, GREGORY J (PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:RYS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 MYRTLE ST OFC 12
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2646
Mailing Address - Country:US
Mailing Address - Phone:814-452-5400
Mailing Address - Fax:814-454-2003
Practice Address - Street 1:2508 MYRTLE ST OFC 12
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2646
Practice Address - Country:US
Practice Address - Phone:814-452-5400
Practice Address - Fax:814-454-2003
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006299L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017897070005Medicaid
S80129Medicare UPIN
PA511644Medicare ID - Type Unspecified