Individual
RYAN PUEBLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1451 VAN HOUTEN AVE, CLIFTON, NJ 07013-2432
(973) 473-2775
Mailing address
14 FLORENCE DR, CLIFTON, NJ 07011-2834
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00702900
NJ
Other
Enumeration date
05/04/2023
Last updated
05/04/2023
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