Provider Demographics
NPI:1093981888
Name:MASTRONARDI, RONALD PAUL
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:PAUL
Last Name:MASTRONARDI
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 1:41 ROME AVE
Mailing Address - Street 2:APT #6A
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2327
Mailing Address - Country:US
Mailing Address - Phone:914-310-7204
Mailing Address - Fax:
Practice Address - Street 1:310 E 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483943-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical