Provider Demographics
NPI:1780874412
Name:JOHN B. RYAN, M.D. PC.
Entity type:Organization
Organization Name:JOHN B. RYAN, M.D. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-258-8282
Mailing Address - Street 1:132 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1829
Mailing Address - Country:US
Mailing Address - Phone:315-258-8282
Mailing Address - Fax:315-258-7386
Practice Address - Street 1:132 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1829
Practice Address - Country:US
Practice Address - Phone:315-258-8282
Practice Address - Fax:315-258-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0052Medicare PIN