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General NPI Number Information
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NPI Number | 1013513373
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Entity Type | Individual
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Provider Name | RYAN DAVID MATISKO DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 159 EAST 74TH ST, FIRST FLOOR
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City | NEW YORK
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State | NY
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Zip | 10021-1002
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Country | US
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Telephone | 212-439-1596
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Fax |
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Provider Business Mailing Address
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Address Line | 159 E 74TH ST STE 3
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City | NEW YORK
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State | NY
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Zip | 10021-3235
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Country | US
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Telephone | 917-774-4600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 046564-01
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License Number State | NY
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