Basic Information
| Provider Information | |||||||||
| NPI: | 1750585428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGDAHL | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1562 1ST AVE # 122 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100284004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127465454 | ||||||||
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| Address1: | 1562 1ST AVE | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127465454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 08/05/2018 | ||||||||
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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 | 282N00000X | N | Hospitals | General Acute Care Hospital | 208600000X | 268129 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.