Provider Demographics
NPI:1366451841
Name:WERTER, RONALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:WERTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WEST END AVE
Mailing Address - Street 2:1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5601
Mailing Address - Country:US
Mailing Address - Phone:212-595-1400
Mailing Address - Fax:212-595-1407
Practice Address - Street 1:160 WEST END AVE
Practice Address - Street 2:1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5601
Practice Address - Country:US
Practice Address - Phone:212-595-1400
Practice Address - Fax:212-595-1407
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002553213E00000X, 213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00405578Medicaid
NY00405578Medicaid
T71171Medicare UPIN
NYP28841Medicare ID - Type Unspecified