Provider Demographics
NPI:1972757615
Name:RYAN, JENNIFER ELKIN (OTR/L, ATP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELKIN
Last Name:RYAN
Suffix:
Gender:F
Credentials:OTR/L, ATP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROBYN
Other - Last Name:ELKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 1ST AVE
Mailing Address - Street 2:ROOM 111
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4004
Mailing Address - Country:US
Mailing Address - Phone:212-802-1530
Mailing Address - Fax:
Practice Address - Street 1:400 1ST AVE
Practice Address - Street 2:ROOM 111
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4004
Practice Address - Country:US
Practice Address - Phone:212-802-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011218-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist