Provider Demographics
NPI:1962477174
Name:SOBEL, RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:SOBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:CONCOURSE LEVEL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-955-5000
Mailing Address - Fax:215-503-6702
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-955-6776
Practice Address - Fax:215-955-4020
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08428100207V00000X
NY222228207V00000X
PAMD435149207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028658330001Medicaid
NY02196207Medicaid
NJ0166723Medicaid
NJ129366 DSQMedicare PIN
PA1028658330001Medicaid
NJ129366 BKRMedicare PIN
NY503E01Medicare ID - Type Unspecified