1366233124 NPI number — MR. RYU ANDRE MARCUS PRIMERO PT

Table of content: MR. RYU ANDRE MARCUS PRIMERO PT (NPI 1366233124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366233124 NPI number — MR. RYU ANDRE MARCUS PRIMERO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRIMERO
Provider First Name:
RYU ANDRE MARCUS
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366233124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72-38 113TH STREET, APT 4B FOREST HILLS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-249-1601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 E 34TH ST, 1E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-651-4380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  050685 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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