Individual
SAMUEL RYU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 NICOLLS RD, LEVLE 2 RADIATION ONCOLOGY, STONY BROOK, NY 11794-7028
(631) 444-7770
Mailing address
101 NICOLLS RD, LEVLE 2 RADIATION ONCOLOGY, STONY BROOK, NY 11794-0001
(631) 444-7770
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
206648
NY
2085R0001X
Radiation Oncology Physician
4301061949
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
415031010
—
MI
01
—
700H262320
BLUE CROSS-BLUE CROSS
—
01
—
SR061949
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
12/08/2006
Last updated
05/02/2022
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