1831149566 NPI number — JEFFREY M CRYAN M.D.

Table of content: JEFFREY M CRYAN M.D. (NPI 1831149566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831149566 NPI number — JEFFREY M CRYAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRYAN
Provider First Name:
JEFFREY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831149566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAILUKU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96793-0117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 MAHALANI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-442-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME95163 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: MA45913 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: MD-20653 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 812390 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0263605 . This is a "AMGP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0263605 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020016583 . This is a "RRM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P831178 . This is a "OX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0100238000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4301156 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4511 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: F02707 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".