Provider Demographics
NPI:1457370728
Name:BRYAN, DUANE B (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:B
Last Name:BRYAN
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 1:206 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2019
Mailing Address - Country:US
Mailing Address - Phone:845-767-5259
Mailing Address - Fax:
Practice Address - Street 1:206 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2019
Practice Address - Country:US
Practice Address - Phone:845-268-0880
Practice Address - Fax:845-268-0882
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208648-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02600508Medicaid
NJ083017Medicare ID - Type Unspecified
NY02600508Medicaid
NYA400104007Medicare PIN