Basic Information
| Provider Information | |||||||||
| NPI: | 1518989797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YU | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | TAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 HARLOW CRES | ||||||||
| Address2: | |||||||||
| City: | FAIR LAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074105233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017978455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 385 TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070181023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
| FaxNumber: | 9733957160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00598400 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.