Healthcare Provider Details

I. General information

NPI: 1841962263
Provider Name (Legal Business Name): HUNTER RYAN YIP LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MOUNTAINVIEW TER
DUNELLEN NJ
08812-1135
US

IV. Provider business mailing address

419 MOUNTAINVIEW TER
DUNELLEN NJ
08812-1135
US

V. Phone/Fax

Practice location:
  • Phone: 908-210-0174
  • Fax:
Mailing address:
  • Phone: 908-210-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01405800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: