Provider Demographics
NPI:1366123895
Name:MORT, RYAN
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:MORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CANAL LANDING BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5111
Mailing Address - Country:US
Mailing Address - Phone:585-360-2540
Mailing Address - Fax:585-360-2571
Practice Address - Street 1:95 CANAL LANDING BLVD STE 5
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5111
Practice Address - Country:US
Practice Address - Phone:585-360-2540
Practice Address - Fax:585-360-2571
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000072344237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist