Provider Demographics
NPI:1376184622
Name:ACCARDO, RYAN (PA STUDENT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:ACCARDO
Suffix:
Gender:M
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 138TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2399
Mailing Address - Country:US
Mailing Address - Phone:201-660-4327
Mailing Address - Fax:
Practice Address - Street 1:125 W 138TH ST APT 2R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2399
Practice Address - Country:US
Practice Address - Phone:201-660-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program