Provider Demographics
NPI:1629075676
Name:RONEN, ALON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALON
Middle Name:
Last Name:RONEN
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 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-333-8800
Mailing Address - Fax:203-333-6054
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-333-8800
Practice Address - Fax:203-333-6054
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2014-11-14
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CT038694207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400133055Medicare PIN
CT060001534Medicare ID - Type Unspecified
CTH16443Medicare UPIN