Healthcare Provider Details

I. General information

NPI: 1346626645
Provider Name (Legal Business Name): CHARLES RYU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ROFF AVE UNIT A
PALISADES PARK NJ
07650-1431
US

IV. Provider business mailing address

110 ROFF AVE UNIT A
PALISADES PARK NJ
07650-1431
US

V. Phone/Fax

Practice location:
  • Phone: 201-450-1170
  • Fax:
Mailing address:
  • Phone: 201-450-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNYX009355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: