Provider Demographics
NPI:1003004383
Name:REINIER RAMIREZ, MD, PC
Entity Type:Organization
Organization Name:REINIER RAMIREZ, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSENBARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-268-1032
Mailing Address - Street 1:6604 STATE HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3545
Mailing Address - Country:US
Mailing Address - Phone:315-268-1032
Mailing Address - Fax:315-268-0910
Practice Address - Street 1:6604 STATE HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3545
Practice Address - Country:US
Practice Address - Phone:315-268-1032
Practice Address - Fax:315-268-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202453-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02220955Medicaid
NY02220955Medicaid
NYAA1454Medicare PIN