Provider Demographics
NPI:1225173727
Name:LIVESEY, RONALD V (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:V
Last Name:LIVESEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 W 50TH STREET, PH4-A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-257-2340
Mailing Address - Fax:917-398-7403
Practice Address - Street 1:345 E 37TH STREET, SUITE 208 THE SALERNO CENTER
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-257-2340
Practice Address - Fax:917-398-7403
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205380207R00000X
NY205380-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA36335Medicare UPIN