Provider Demographics
NPI:1336345313
Name:HOUSAM, RYAN (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HOUSAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3322 ROUTE 22 STE 1002
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-4403
Mailing Address - Country:US
Mailing Address - Phone:908-725-5530
Mailing Address - Fax:
Practice Address - Street 1:3322 ROUTE 22 STE 1002
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-4403
Practice Address - Country:US
Practice Address - Phone:908-725-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190141208000000X
PAMD438508208000000X
NJ25MA09108300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics