Provider Demographics
NPI:1720031586
Name:RYAN, DENISE KIM (APRN, BC; MSN)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:KIM
Last Name:RYAN
Suffix:
Gender:F
Credentials:APRN, BC; MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5027
Mailing Address - Country:US
Mailing Address - Phone:718-743-2249
Mailing Address - Fax:
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:DAY HOSPITAL PROGRAM-16TH FLOOR-ROOM 16-104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY386253-1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult