Healthcare Provider Details

I. General information

NPI: 1457215873
Provider Name (Legal Business Name): RYAN MOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 RALPH AVE
BROOKLYN NY
11234-5515
US

IV. Provider business mailing address

2520 E 27TH ST
BROOKLYN NY
11235-2017
US

V. Phone/Fax

Practice location:
  • Phone: 718-209-8121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: