Provider Demographics
NPI:1043603343
Name:INFANTINO, RONALD (MS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:INFANTINO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2408
Mailing Address - Country:US
Mailing Address - Phone:631-926-7524
Mailing Address - Fax:
Practice Address - Street 1:121 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2408
Practice Address - Country:US
Practice Address - Phone:631-926-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst