Provider Demographics
NPI:1598035065
Name:MONACO, RYAN M (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:MONACO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 JUDD RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-3610
Mailing Address - Country:US
Mailing Address - Phone:315-765-6187
Mailing Address - Fax:
Practice Address - Street 1:5241 JUDD RD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-3610
Practice Address - Country:US
Practice Address - Phone:315-765-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034595-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313539Medicaid
NY01815443Medicaid
NY00313539Medicaid
NY335475Medicare Oscar/Certification