1689757072 NPI number — RONALD M GUBERMAN DPM

Table of content: RONALD M GUBERMAN DPM (NPI 1689757072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689757072 NPI number — RONALD M GUBERMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUBERMAN
Provider First Name:
RONALD
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1689757072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6083 MYRTLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385-5908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-381-8402
Provider Business Mailing Address Fax Number:
718-497-7322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 MAMARONECK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAMARONECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10543-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-381-4440
Provider Business Practice Location Address Fax Number:
718-497-7322
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  N004232 , 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: PG9791 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01040239 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36851P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 865502 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WS839 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 165296 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1400248 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com