Healthcare Provider Details

I. General information

NPI: 1578840062
Provider Name (Legal Business Name): RYU PHYSICAL THERAPY OF NEW YORK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 VAN CORTLANDT PARK AVE SUITE 2C
YONKERS NY
10705-3368
US

IV. Provider business mailing address

16-10 LUCENA DR
FAIR LAWN NJ
07410-5358
US

V. Phone/Fax

Practice location:
  • Phone: 201-218-8391
  • Fax: 866-903-4166
Mailing address:
  • Phone: 201-218-8391
  • Fax: 201-300-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number28259
License Number StateNY

VIII. Authorized Official

Name: HOLLY SANTIAGO
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 201-218-8391