Provider Demographics
NPI:1639230758
Name:STEVENS, RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:STEVENS
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 1:166 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2098
Mailing Address - Country:US
Mailing Address - Phone:516-408-3423
Mailing Address - Fax:516-294-2734
Practice Address - Street 1:166 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2098
Practice Address - Country:US
Practice Address - Phone:516-408-3423
Practice Address - Fax:516-294-2734
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209886207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
201285536OtherUHC
NY01920332Medicaid
118397OtherVYTRA
5460420OtherCIGNA
7249304OtherAETNA
201285536OtherEMPIRE
201285536OtherHORIZON
AA72388AOtherMDNY
P00235529OtherRR MCR
193073POtherHIP
2590248OtherGHI
292AU1OtherBLUE CROSS BLUE SHIELD
4C9691OtherHEALTHNET
P1219927OtherOXFORD
4C9691OtherHEALTHNET
NY01920332Medicaid