Provider Demographics
NPI:1891857199
Name:RYDER, PAMELA (NP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:RYDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-0460
Mailing Address - Country:US
Mailing Address - Phone:646-498-3049
Mailing Address - Fax:
Practice Address - Street 1:765 STREETER HILL RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:12093
Practice Address - Country:US
Practice Address - Phone:646-498-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily