Healthcare Provider Details

I. General information

NPI: 1285337683
Provider Name (Legal Business Name): ANDREW RYU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 FORT HAMILTON PKWY
BROOKLYN NY
11219
US

IV. Provider business mailing address

8855 BAY PKWY APT 2N
BROOKLYN NY
11214-6422
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-6000
  • Fax:
Mailing address:
  • Phone: 646-265-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number343270-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: