Provider Demographics
NPI:1922186204
Name:TIO, RUY CHEN (DO)
Entity Type:Individual
Prefix:MR
First Name:RUY
Middle Name:CHEN
Last Name:TIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 EAST 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-336-1015
Mailing Address - Fax:718-375-0810
Practice Address - Street 1:1715 EAST 17TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-336-1015
Practice Address - Fax:718-375-0810
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184647207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01356885Medicaid
1000017395OtherAFFINITY
160178OOtherHIP BROOKLYN OFFICE
69K841OtherBLUE CROSS BLUE SHIELD
3246OtherGENESIS
6100378OtherGHI
032640OtherBETTER HEALTH
0508978OtherAETNA US HEALTH NASSAU
1068855OtherFIRST HEALTH
5303335OtherAETNA US HEALTH BROOKLYN
00323500102OtherHEALTH PLUS
160180POtherHIP QUEENS OFFICE
71824OtherANTHEM HEALTH NETWORK
5303335OtherAETNA US HEALTH BROOKLYN
NY69K841Medicare PIN
6100378OtherGHI
69K841OtherBLUE CROSS BLUE SHIELD