Provider Demographics
NPI:1245593631
Name:MRWIK, RONALD THORGEN
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:THORGEN
Last Name:MRWIK
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 1:68-37 YELLOWSTONE BLVD.
Mailing Address - Street 2:D-13
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3456
Mailing Address - Country:US
Mailing Address - Phone:917-620-3203
Mailing Address - Fax:
Practice Address - Street 1:68-37 YELLOWSTONE BLVD
Practice Address - Street 2:D-13
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3456
Practice Address - Country:US
Practice Address - Phone:917-620-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist