| Doctor Name: | MR. RANDALL GARTH RYAN |
| NPI Number: | 1124489455 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | F340109-1 |
| Business Practice Address: | 16 Barrington Dr Wheatley Heights, NY - 117981302 |
| Business Phone Number: | 3472474491 |
| Business Fax Number: | |
| Mailing Address: | 16 Barrington Dr, WHEATLEY HEIGHTS |
| State: | NY |
| Postal Code: | 117981302 |
| Phone Number: | 3472474491 |
| Fax Number: | |
| NPI Enumeration Date: | 03/15/2016 |
| NPI Last Update Date: | 03/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | F340109-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |