Provider Demographics
NPI:1689757072
Name:GUBERMAN, RONALD M (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:GUBERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5908
Mailing Address - Country:US
Mailing Address - Phone:718-381-8402
Mailing Address - Fax:718-497-7322
Practice Address - Street 1:135 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3712
Practice Address - Country:US
Practice Address - Phone:914-381-4440
Practice Address - Fax:718-497-7322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004232213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPG9791OtherBC/BS
NY01040239Medicaid
NY36851POtherHIP
NY865502OtherAETNA
NYWS839OtherOXFORD
NY165296OtherELDERPLAN
NY1400248OtherGHI
NY165296OtherELDERPLAN
NYT51410Medicare UPIN
NYWS839OtherOXFORD