Provider Demographics
NPI:1033147426
Name:PIMENTEL, RAMON R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:R
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29046
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9046
Mailing Address - Country:US
Mailing Address - Phone:718-803-7300
Mailing Address - Fax:718-478-5198
Practice Address - Street 1:3744 75TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6444
Practice Address - Country:US
Practice Address - Phone:718-803-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212292-1207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01900054Medicaid
NY01900054Medicaid
NY05165GMedicare PIN