Basic Information
| Provider Information | |||||||||
| NPI: | 1407997216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KITZEN | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 ANDREWS DRIVE | ||||||||
| Address2: | |||||||||
| City: | MANHASSETT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110302312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 E 56TH ST | ||||||||
| Address2: | SUITE 1010 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100223607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592211 | ||||||||
| FaxNumber: | 2128291189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 10/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 028851 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1407997216 | 01 | NY | NPI | OTHER |