Provider Demographics
NPI:1912424862
Name:RYU, JASON CHRISTIAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTIAN
Last Name:RYU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 10TH AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3090
Mailing Address - Country:US
Mailing Address - Phone:214-284-8072
Mailing Address - Fax:
Practice Address - Street 1:10 COLUMBUS CIR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1158
Practice Address - Country:US
Practice Address - Phone:212-823-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042191208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation