Provider Demographics
NPI:1275726531
Name:MINGE, M RONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:RONALD
Last Name:MINGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VAN KLEECK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3129
Mailing Address - Country:US
Mailing Address - Phone:845-255-8396
Mailing Address - Fax:845-255-1620
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:SUITE 325
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1762
Practice Address - Country:US
Practice Address - Phone:845-255-8396
Practice Address - Fax:845-255-1620
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4073-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000912819003OtherUNITED HEALTH CARE
NYP481561OtherOXFORD
NY0015306OtherGHI
NY01776012Medicaid
NY144525OtherVALUE OPTIONS
NYV4A331Medicare PIN