Active NPI
Thomas Gerard Ryan, LICAC
- Acupuncturist
- Old Saybrook, CT
National Provider Identifier
1417355769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 000001
- Practice address
- 455 Boston Post Rd
Suite 203a
Old Saybrook, CT 06475-1516 - Phone
- (860) 395-1119
- NPI assigned
- Dec 18, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 000001 | CT | Primary |
Addresses
Primary practice location
455 Boston Post Rd
Suite 203a
Old Saybrook, CT 06475-1516
Mailing address
455 Boston Post Rd
Suite 203a
Old Saybrook, CT 06475-1516
Phone (860) 395-1119
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013019462 | Other | CT | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000001 | CT | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418860800000",
"number": "1417355769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 BOSTON POST RD",
"address_2": "SUITE 203A",
"city": "OLD SAYBROOK",
"state": "CT",
"postal_code": "064751516",
"telephone_number": "860-395-1119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 BOSTON POST RD",
"address_2": "SUITE 203A",
"city": "OLD SAYBROOK",
"state": "CT",
"postal_code": "064751516",
"telephone_number": "860-395-1119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "THOMAS",
"middle_name": "GERARD",
"name_prefix": "Mr.",
"credential": "LICAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-18",
"last_updated": "2014-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CT",
"license": "000001",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA",
"identifier": "1013019462",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Old Saybrook, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.