Provider Demographics
NPI:1427027887
Name:FORLENZA, RONALD SAMUEL (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:SAMUEL
Last Name:FORLENZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4250 HEMPSTEAD TPKE
Mailing Address - Street 2:23
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-735-3133
Mailing Address - Fax:516-735-1056
Practice Address - Street 1:4250 HEMPSTEAD TPKE
Practice Address - Street 2:23
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-735-3133
Practice Address - Fax:516-735-1056
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY112104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00941479Medicaid
A91301Medicare UPIN
NY00941479Medicaid