Healthcare Provider Details

I. General information

NPI: 1942098736
Provider Name (Legal Business Name): JOSEPH W RYU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

5 HAZLITT AVE UNIT B
FORT LEE NJ
07024-2514
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-2778
  • Fax:
Mailing address:
  • Phone: 201-546-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: