Provider Demographics
NPI:1891053138
Name:MANUEL, RYAN FENTLEY GARCIA (RPT)
Entity Type:Individual
Prefix:MR
First Name:RYAN FENTLEY
Middle Name:GARCIA
Last Name:MANUEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BROADWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1743
Mailing Address - Country:US
Mailing Address - Phone:845-796-2470
Mailing Address - Fax:845-796-1420
Practice Address - Street 1:427 BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1743
Practice Address - Country:US
Practice Address - Phone:845-796-2470
Practice Address - Fax:845-796-1420
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030826-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist