Provider Demographics
NPI:1497717631
Name:UMANSKY, RONALD JAY (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAY
Last Name:UMANSKY
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 1:1445 PORTLAND AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-338-2233
Mailing Address - Fax:585-338-3483
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-338-2233
Practice Address - Fax:585-338-3483
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS124233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
28316BMedicare ID - Type Unspecified
B76801Medicare UPIN