Provider Demographics
NPI:1215098025
Name:LITTLE, RYAN DANIEL (NP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DANIEL
Last Name:LITTLE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVENUE
Mailing Address - Street 2:UNITED HEALTH SERVICES HOSP INC
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:33 MITCHELL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1619
Practice Address - Country:US
Practice Address - Phone:607-762-3281
Practice Address - Fax:607-762-3295
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02805301Medicaid
NYRB8734Medicare PIN