Provider Demographics
NPI:1477545812
Name:HERSHMAN, RONNIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:A
Last Name:HERSHMAN
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 1:1999 MARCUS AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1021
Mailing Address - Country:US
Mailing Address - Phone:516-869-5400
Mailing Address - Fax:516-869-5800
Practice Address - Street 1:1999 MARCUS AVE STE 220
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1021
Practice Address - Country:US
Practice Address - Phone:516-869-5400
Practice Address - Fax:516-869-5800
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1559321207RI0011X
NY155932207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00870902Medicaid
63B321Medicare PIN
NY00870902Medicaid