Provider Demographics
NPI:1174299648
Name:OTTO-RYAN, ANGELA (DNP, APN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:OTTO-RYAN
Suffix:
Gender:F
Credentials:DNP, APN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ROUTE 10 E STE 203
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1925
Mailing Address - Country:US
Mailing Address - Phone:973-659-9991
Mailing Address - Fax:
Practice Address - Street 1:765 ROUTE 10 E STE 203
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1925
Practice Address - Country:US
Practice Address - Phone:973-659-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01183700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics