Provider Demographics
NPI:1346707544
Name:MAGALONG-DAVIS, RALPH RYAN
Entity Type:Individual
Prefix:
First Name:RALPH RYAN
Middle Name:
Last Name:MAGALONG-DAVIS
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 1:8412 35TH AVE APT 2I
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5463
Mailing Address - Country:US
Mailing Address - Phone:718-360-7622
Mailing Address - Fax:
Practice Address - Street 1:8412 35TH AVE APT 2I
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5463
Practice Address - Country:US
Practice Address - Phone:718-360-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576075367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered