Provider Demographics
NPI:1780254227
Name:MEDRY, LLC
Entity type:Organization
Organization Name:MEDRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JOINT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-708-9164
Mailing Address - Street 1:544 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7575
Mailing Address - Country:US
Mailing Address - Phone:504-708-9164
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD STE 750
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3197
Practice Address - Country:US
Practice Address - Phone:504-340-6976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty