Provider Demographics
NPI:1356412670
Name:RYAN, WILLIAM J (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2092 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3147
Practice Address - Country:US
Practice Address - Phone:516-223-4300
Practice Address - Fax:516-223-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007794-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4535106OtherAETNA
NYAS128OtherOXFORD
NY818044OtherMANAGED PHYSICAL NETWORK
NY0209201OtherORTHONET FOR AETNA
NY970929OtherHEALTHCARE PARTNERS
NYNZ9204OtherHEALTHNET
NYQ55271OtherBCBS
NY818044OtherMANAGED PHYSICAL NETWORK