1740055961 NPI number — RYAN ALFRED KERNER DC

Table of content: RYAN ALFRED KERNER DC (NPI 1740055961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740055961 NPI number — RYAN ALFRED KERNER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERNER
Provider First Name:
RYAN
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1740055961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 CRINGLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISONVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12962-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-569-8321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 DURKEE ST STE 600C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-324-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2023

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: 111N00000X , with the licence number:  PENDINGGRADUATION , 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)