1093803835 NPI number — RYAN KALMAN PT

Table of content: RYAN KALMAN PT (NPI 1093803835)

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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