Provider Demographics
NPI:1043319692
Name:GMEREK, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:GMEREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JEFFERSON RD
Mailing Address - Street 2:STE 203
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3158
Mailing Address - Country:US
Mailing Address - Phone:585-226-9340
Mailing Address - Fax:585-226-6704
Practice Address - Street 1:102 GENESEE ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1222
Practice Address - Country:US
Practice Address - Phone:585-226-9340
Practice Address - Fax:585-226-6704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005586-01213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83-0345421OtherUNITED HEALTH CARE
NY02146569Medicaid
NY7101267OtherAETNA
NYMDH352OtherPREFERRED CARE
NYG0184705620OtherFINGER LAKES
NY000924073002OtherBC / BS OF WNY
NY106819EQOtherPREFERRED CARE
NYP030005586OtherBLUE CROSS / BLUE SHIELD
NYP00074369OtherMEDICARE RAILROAD
NYP010005586OtherBLUE CHOICE
NC5008670001Medicare NSC
NY7101267OtherAETNA