Provider Demographics
NPI:1760937098
Name:RONNER, RICHARD (NP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RONNER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 34TH AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4329
Mailing Address - Country:US
Mailing Address - Phone:917-929-8430
Mailing Address - Fax:
Practice Address - Street 1:4415 34TH AVE APT 3D
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1057
Practice Address - Country:US
Practice Address - Phone:917-929-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4020762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY402076OtherNEW YORK STATE OFFICE OF THE PROFESSIONS NURSE PRACTITIONER LICENSE NUMBER