Individual
MR. ENEIL RYAN DE LA PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ANP-BC, GNP
Contact information
Practice address
161 FORT WASHINGTON AVE, NEW YORK, NY 10032-3729
(646) 298-6099
Mailing address
630 W 168TH ST # 4, NEW YORK, NY 10032-3725
(646) 298-6099
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
306096
NY
363LG0600X
Gerontology Nurse Practitioner
340846
NY
Other
Enumeration date
07/19/2013
Last updated
03/17/2018
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