1497163885 NPI number — MR. RYAN NORMAL DEGON MS, ATC, CEAS

Table of content: MR. RYAN NORMAL DEGON MS, ATC, CEAS (NPI 1497163885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497163885 NPI number — MR. RYAN NORMAL DEGON MS, ATC, CEAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGON
Provider First Name:
RYAN
Provider Middle Name:
NORMAL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC, CEAS
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:
1497163885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 150
Provider Second Line Business Mailing Address:
WORK-FIT AT ALCOA MASSENA OPERATIONS
Provider Business Mailing Address City Name:
MASSENA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13662-0150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-764-4223
Provider Business Mailing Address Fax Number:
315-764-4404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PARK AVENUE EAST
Provider Second Line Business Practice Location Address:
WORK-FIT AT ALCOA MASSENA OPERATIONS
Provider Business Practice Location Address City Name:
MASSENA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-764-4223
Provider Business Practice Location Address Fax Number:
315-764-4404
Provider Enumeration Date:
07/29/2014

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: 2255A2300X , with the licence number:  002195-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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