Provider Demographics
NPI:1518038009
Name:SOLLAZZO, RONNI (MD)
Entity Type:Individual
Prefix:
First Name:RONNI
Middle Name:
Last Name:SOLLAZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 RESEARCH WAY STE 208A
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-675-2125
Mailing Address - Fax:631-675-2628
Practice Address - Street 1:267 E MAIN ST BLDG C
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2847
Practice Address - Country:US
Practice Address - Phone:631-418-8069
Practice Address - Fax:631-638-4926
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165065207P00000X
NY165065-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01327164Medicaid
NY06H172Medicare ID - Type Unspecified
NY01327164Medicaid