Provider Demographics
NPI:1982054185
Name:ST. PIERRE-HETZ, RYAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
Last Name:ST. PIERRE-HETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:EDWARD
Other - Last Name:ST. PIERRE-HETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:622 W 168TH ST STE VC260
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-6204
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST STE VC260
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3295232080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine