Provider Demographics
NPI:1114516606
Name:OOMMEN, RYAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:OOMMEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2424
Mailing Address - Country:US
Mailing Address - Phone:516-776-7631
Mailing Address - Fax:718-360-4908
Practice Address - Street 1:179 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2424
Practice Address - Country:US
Practice Address - Phone:516-776-7631
Practice Address - Fax:718-360-4908
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist