Healthcare Provider Details

I. General information

NPI: 1134625734
Provider Name (Legal Business Name): RYAN THOMAS DOSUMU-JOHNSON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 CENTRAL PARK W APT 1A
NEW YORK NY
10024-4111
US

IV. Provider business mailing address

251 CENTRAL PARK W APT 1A
NEW YORK NY
10024-4111
US

V. Phone/Fax

Practice location:
  • Phone: 718-865-3369
  • Fax: 718-691-3820
Mailing address:
  • Phone: 718-865-3369
  • Fax: 718-691-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number300243
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number300243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: