Individual
DR. JAE RYU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
133-47 SANFORD AVENUE, FLUSHING, NY 11355
(718) 359-1507
Mailing address
80 MARCUS DRIVE, PROVIDER ENROLLMENT, MELVILLE, NY 11747
(631) 391-7887
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
217530
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02289430
—
NY
Enumeration date
11/06/2006
Last updated
07/08/2007
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