Provider Demographics
NPI:1689796781
Name:RYAN, JAMES J (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:RPA-C
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Other - First Name:
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Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4626
Mailing Address - Country:US
Mailing Address - Phone:845-334-2700
Mailing Address - Fax:845-334-2898
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4626
Practice Address - Country:US
Practice Address - Phone:845-334-2700
Practice Address - Fax:845-334-2898
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant