Provider Demographics
NPI:1033169537
Name:MAIMON, RON (MD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:MAIMON
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 1:2791 RICHMOND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5859
Mailing Address - Country:US
Mailing Address - Phone:718-816-3710
Mailing Address - Fax:718-228-8141
Practice Address - Street 1:2095 FLATBUSH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-0000
Practice Address - Country:US
Practice Address - Phone:718-338-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2354102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02602188Medicaid
NYI07716Medicare UPIN
NYRM0805S810Medicare PIN
NY02602188Medicaid