Provider Demographics
NPI:1518069434
Name:RANIOLO, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RANIOLO
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 1:777 N BROADWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1000
Mailing Address - Country:US
Mailing Address - Phone:914-631-3660
Mailing Address - Fax:914-631-0290
Practice Address - Street 1:777 N BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1000
Practice Address - Country:US
Practice Address - Phone:914-631-3660
Practice Address - Fax:914-631-0290
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154078208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01071154Medicaid
NY22E671Medicare ID - Type Unspecified
NY01071154Medicaid