Individual
PHILIP RYDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
596 CENTER BRIARWOOD AVE, WEST ISLIP, NY 11795-4004
(191) 449-7291
Mailing address
596 CENTER BRIARWOOD AVE, WEST ISLIP, NY 11795-4004
(191) 449-7291
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002240
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000002396
ATHLETIC TRAINER
NY
01
—
2000002396
ATHLETIC TRAINER
—
Enumeration date
07/19/2022
Last updated
07/19/2022
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