1578840062 NPI number — RYU PHYSICAL THERAPY OF NEW YORK, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578840062 NPI number — RYU PHYSICAL THERAPY OF NEW YORK, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RYU PHYSICAL THERAPY OF NEW YORK, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578840062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16-10 LUCENA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-5358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-218-8391
Provider Business Mailing Address Fax Number:
201-300-6397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
498 VAN CORTLANDT PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10705-3368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-218-8391
Provider Business Practice Location Address Fax Number:
866-903-4166
Provider Enumeration Date:
11/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
201-218-8391

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  28259 , 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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