Provider Demographics
NPI:1053486100
Name:SIDORSKY, RONALD MARC (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MARC
Last Name:SIDORSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 ROUTE 10 EAST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-824-8201
Mailing Address - Fax:973-824-0670
Practice Address - Street 1:3155 ROUTE 10 EAST
Practice Address - Street 2:SUITE 215
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-824-8201
Practice Address - Fax:973-824-0670
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00116800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T44809Medicare UPIN
NJ165691Medicare PIN