Basic Information
| Provider Information | |||||||||
| NPI: | 1346682622 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBERTS | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 MADISON AVE | ||||||||
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| City: | OLEAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147601616 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 135 N UNION ST | ||||||||
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| City: | OLEAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147602736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163757500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2013 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PT617 | WY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 021544 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.