1346590544 NPI number — RONAK MEDICAL CARE PC

Table of content: (NPI 1346590544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346590544 NPI number — RONAK MEDICAL CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONAK MEDICAL CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346590544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
765 AMSTERDAM AVE
Provider Second Line Business Mailing Address:
STE 1F
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10025-5722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-663-3600
Provider Business Mailing Address Fax Number:
212-663-3603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 AMSTERDAM AVE
Provider Second Line Business Practice Location Address:
STE 1F
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-5722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-663-3600
Provider Business Practice Location Address Fax Number:
212-663-3603
Provider Enumeration Date:
09/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
GIRISH
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
212-663-3600

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  193928 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP1330 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 164996 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 229623 . This is a "WELLCARE OF NEW YORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4935247011 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 075AA2 . This is a "EMPIRE BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112089P . This is a "HIP OF NEW YORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2594037 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: RMCO-0087 . This is a "METROPLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110088503 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01467918 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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