Provider Demographics
NPI:1063034890
Name:DELRAHIM, RONIT (NP)
Entity Type:Individual
Prefix:MRS
First Name:RONIT
Middle Name:
Last Name:DELRAHIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 GRACE AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2622
Mailing Address - Country:US
Mailing Address - Phone:443-468-1321
Mailing Address - Fax:
Practice Address - Street 1:46 GRACE AVE APT 3F
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2622
Practice Address - Country:US
Practice Address - Phone:443-368-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY699218163WC0200X
NY344755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine