Ryan William Logan
Physician Assistant in Brooklyn, NY. Individual provider (NPI-1).
NPI number1962030189
StatusActive
Last updated in NPPESOct 1, 2026
Details
- NPI
- 1962030189
- Entity type
- Individual (NPI-1)
- Name
- Ryan William Logan
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 1, 2020
- Certification date
- Oct 1, 2026
- Last updated
- Oct 1, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 025151 | NY | Yes |
| 363A00000X | Physician Assistant | PA9113132 | FL |
Practice location
399 Knickerbocker AveBrooklyn, NY 11237-4101
Phone 718-571-9168
Mailing address
399 Knickerbocker AveBrooklyn, NY 11237-4101
Phone 718-571-9168
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