Provider Demographics
NPI:1912593138
Name:RYOO, LISA SUHYUN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUHYUN
Last Name:RYOO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1624
Mailing Address - Country:US
Mailing Address - Phone:201-655-8424
Mailing Address - Fax:
Practice Address - Street 1:301 SICOMAC AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2159
Practice Address - Country:US
Practice Address - Phone:201-655-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00957200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist