Provider Demographics
NPI:1679134258
Name:BRYAN, ISAMAR (CM)
Entity type:Individual
Prefix:
First Name:ISAMAR
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 E 131ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2905
Mailing Address - Country:US
Mailing Address - Phone:212-281-8600
Mailing Address - Fax:
Practice Address - Street 1:68 E 131ST ST STE 100
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2905
Practice Address - Country:US
Practice Address - Phone:212-281-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001929367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife