Healthcare Provider Details

I. General information

NPI: 1407997216
Provider Name (Legal Business Name): RYAN KITZEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 56TH ST SUITE 1010
NEW YORK NY
10022-3607
US

IV. Provider business mailing address

30 ANDREWS DRIVE
MANHASSETT NY
11030-2312
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-2211
  • Fax: 212-829-1189
Mailing address:
  • Phone: 212-759-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: