Provider Demographics
NPI:1578840062
Name:RYU PHYSICAL THERAPY OF NEW YORK, P.C.
Entity Type:Organization
Organization Name:RYU PHYSICAL THERAPY OF NEW YORK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-218-8391
Mailing Address - Street 1:16-10 LUCENA DR
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5358
Mailing Address - Country:US
Mailing Address - Phone:201-218-8391
Mailing Address - Fax:201-300-6397
Practice Address - Street 1:498 VAN CORTLANDT PARK AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3368
Practice Address - Country:US
Practice Address - Phone:201-218-8391
Practice Address - Fax:866-903-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28259261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400047261Medicare UPIN