Provider Demographics
NPI:1316960602
Name:RYNN, MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RYNN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 VETERANS AVE
Mailing Address - Street 2:4TH FLOOR SPECIALTY CLINIC
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-0810
Mailing Address - Country:US
Mailing Address - Phone:607-664-4608
Mailing Address - Fax:607-664-4643
Practice Address - Street 1:76 VETERANS AVE
Practice Address - Street 2:4TH FLOOR SPECIALTY CLINIC
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-0810
Practice Address - Country:US
Practice Address - Phone:607-664-4608
Practice Address - Fax:607-664-4643
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003367213E00000X
NJ25MD00313000213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY546200OtherMEDICARE E SUBMITTER
NY8068OtherBLUE SHIELD OF ROCHESTER
NY101843EQOtherPREFERRED CARE
NY161193159OtherBLUE SHIELD OF CENTRAL NE
NYT26171Medicare UPIN
NYP00095665OtherRAILROAD MEDICARE PIN
NYP010003367OtherBLUE CHOICE
NY17560AMedicare PIN
NY54620AMedicare PIN
NY900197OtherMVP HEALTH PLAN
NY00750225Medicaid
NY175600OtherMEDICARE E SUBMITTER