Provider Demographics
NPI:1902887334
Name:SY, ROBERT RYAN CRUZ (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT RYAN
Middle Name:CRUZ
Last Name:SY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 WAIALAE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5316
Mailing Address - Country:US
Mailing Address - Phone:845-636-3044
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE STE 303
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5316
Practice Address - Country:US
Practice Address - Phone:845-636-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022079225100000X
HIPT5570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02715382Medicaid
NYQP29806761Medicare PIN
NYP71169Medicare UPIN