1093803835 NPI number — RYAN KALMAN PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093803835 NPI number — RYAN KALMAN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALMAN
Provider First Name:
RYAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1093803835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
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:
1111 ELM ST
Provider Second Line Business Practice Location Address:
SUITE 33
Provider Business Practice Location Address City Name:
WEST SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01089-1540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-526-9969
Provider Business Practice Location Address Fax Number:
413-526-9960
Provider Enumeration Date:
10/10/2006

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: 225100000X , with the licence number:  11830 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000035332 . This is a "BOSTON MEDICAL HEALTH NET INDIVIDUAL NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "AETNA GROUP NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00194754 . This is a "PALMETTO RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "GREATWEST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 28117 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 690675 . This is a "TUFTS GROUP NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0329819 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 467738 . This is a "TUFTS INDIVIDUAL NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 972730 . This is a "NETWORK HEALTH GROUP NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y61264 . This is a "BC BS GROUP NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "PIONEER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11222892 . This is a "CAQH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y67756 . This is a "BC BS INDIVIDUAL NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000035257 . This is a "BOSTON MEDICAL HEALTH NET GROUP NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6118324 . This is a "CIGNA INDIVIDUAL NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "UNICARE/GIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "CIGNA GROUP NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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