Healthcare Provider Details

I. General information

NPI: 1639086069
Provider Name (Legal Business Name): RYAN D MAXWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 3RD AVE STE 402
BRONX NY
10455-4073
US

IV. Provider business mailing address

1442 E 92ND ST
BROOKLYN NY
11236-5008
US

V. Phone/Fax

Practice location:
  • Phone: 718-520-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: