Provider Demographics
NPI:1922484492
Name:WHITCOMB, RYAN (RD)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 TOWN SQUARE PL STE 517
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1756
Mailing Address - Country:US
Mailing Address - Phone:201-335-0520
Mailing Address - Fax:
Practice Address - Street 1:123 TOWN SQUARE PL STE 517
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1756
Practice Address - Country:US
Practice Address - Phone:866-321-2035
Practice Address - Fax:888-506-7860
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1073431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered