Individual ProviderKathleen Teresa RyanSpecialistOther Service ProvidersPractice Address38 Buckingham Dr, Holbrook, NY 11741-2880(631) 738-0310(631) 780-6014PECOS EnrollmentBased on the most recent information from CMS, provider Kathleen Teresa Ryan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:04 PM.Profile DetailsProvider ID1053661439Provider TypeIndividualFull NameRyan, Kathleen TeresaTitleMrs.GenderFemaleSole ProprietorNoEnumeration Date9/13/2012Last Updated9/13/2012Contact InformationPractice LocationPractice Address38 Buckingham Dr, Holbrook, NY 11741-2880Phone(631) 738-0310FaxUnlisted FaxMailing LocationMailing Address16 Dogwood Dr, Smithtown, NY 11787-2211Phone(631) 780-6014FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicense1121240New York