1659441038 NPI number — SUSAN F RYAN RN, NPP

Table of content: SUSAN F RYAN RN, NPP (NPI 1659441038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659441038 NPI number — SUSAN F RYAN RN, NPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
SUSAN
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, NPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAVARO
Provider Other First Name:
SUSAN
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659441038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CARTER COURT
Provider Second Line Business Mailing Address:
PO BOX 905
Provider Business Mailing Address City Name:
DANNEMORA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12929-0905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-492-7066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 PARK STREET
Provider Second Line Business Practice Location Address:
CITIZEN ADVOCATES
Provider Business Practice Location Address City Name:
MALONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-483-3261
Provider Business Practice Location Address Fax Number:
518-483-3383
Provider Enumeration Date:
11/09/2006

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: 163W00000X , with the licence number:  517230-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 401323 , 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)