Provider Demographics
NPI:1356331854
Name:BRENZA, RYAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:BRENZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 SHUNPIKE RD UNIT 301
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4402
Practice Address - Country:US
Practice Address - Phone:860-358-5280
Practice Address - Fax:860-358-8650
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47860207Q00000X
ARE-6825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36863Medicare UPIN