Provider Demographics
NPI:1396754966
Name:RYAN, RICHARD ROBERT
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROBERT
Last Name:RYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:ROBERT
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:20 TOTTEN CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2800
Mailing Address - Country:US
Mailing Address - Phone:732-617-5951
Mailing Address - Fax:
Practice Address - Street 1:13 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2526
Practice Address - Country:US
Practice Address - Phone:732-431-6674
Practice Address - Fax:732-780-3752
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093366Medicare PIN
NJU93346Medicare UPIN