Provider Demographics
NPI:1407915838
Name:RYAN, GAIL REMSEM (RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:REMSEM
Last Name:RYAN
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:N BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5539
Mailing Address - Country:US
Mailing Address - Phone:631-422-4550
Mailing Address - Fax:
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-376-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001351133V00000X
IL690648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered