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General NPI Number Information
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NPI Number | 1922506062
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Entity Type | Individual
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Provider Name | MR. RYAN MATTHEW DRITZ
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Gender | Male
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 1745 BROADWAY FL 17
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City | NEW YORK
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State | NY
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Zip | 10019-4642
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Country | US
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Telephone | 646-942-1881
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Fax | 646-942-1881
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Provider Business Mailing Address
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Address Line | 410 ST. NICHOLAS AVENUE APARTMENT 16H
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City | NEW YORK
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State | NY
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Zip | 10027
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Country | US
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Telephone | 646-942-1881
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 085311
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License Number State | NY
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