Provider Demographics
NPI:1235306341
Name:VENK, RONALD REXFORD (LAC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:REXFORD
Last Name:VENK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 6TH AVE
Mailing Address - Street 2:APT. # 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4045
Mailing Address - Country:US
Mailing Address - Phone:917-817-7418
Mailing Address - Fax:
Practice Address - Street 1:20 W 22ND ST
Practice Address - Street 2:SUITE 1402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5804
Practice Address - Country:US
Practice Address - Phone:917-817-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002899171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist