Provider Demographics
NPI:1265458095
Name:KANAS, RONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:KANAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1559
Mailing Address - Country:US
Mailing Address - Phone:604-748-7468
Mailing Address - Fax:607-754-6130
Practice Address - Street 1:200 FRONT ST
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1559
Practice Address - Country:US
Practice Address - Phone:604-748-7468
Practice Address - Fax:607-754-6130
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCAN170710OtherWORKERS COMP
NY02504OtherAMERICAN BOARD OF PAIN ME
NY01191602Medicaid
NY01191602Medicaid
NY02504OtherAMERICAN BOARD OF PAIN ME