Provider Demographics
NPI:1962668442
Name:RYOO, SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:RYOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ELMONT RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4002
Mailing Address - Country:US
Mailing Address - Phone:516-354-4200
Mailing Address - Fax:516-775-1972
Practice Address - Street 1:227 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1902
Practice Address - Country:US
Practice Address - Phone:516-295-5500
Practice Address - Fax:516-569-8225
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2504262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03256508Medicaid
NYA400049674Medicare PIN
NY03256508Medicaid
NYA400059598Medicare PIN
NYA400041316Medicare PIN
NYG400023935Medicare PIN
NYG400023936Medicare PIN
NYG400023937Medicare PIN