Provider Demographics
NPI:1447534334
Name:RYERSON, BRIDGET (PA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:RYERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:BS22
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-7052
Mailing Address - Fax:
Practice Address - Street 1:1400 PEHLAM PARKWAY SOUTH
Practice Address - Street 2:BS 22
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23 015169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant