Provider Demographics
NPI:1912370453
Name:MCNERNEY, RYAN (COMS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:MCNERNEY
Suffix:
Gender:M
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2331
Mailing Address - Country:US
Mailing Address - Phone:716-888-4595
Mailing Address - Fax:
Practice Address - Street 1:1170 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2331
Practice Address - Country:US
Practice Address - Phone:716-888-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7654225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
7654OtherACVREP