Provider Demographics
NPI:1780657700
Name:LONNER, BARON S (MD)
Entity Type:Individual
Prefix:DR
First Name:BARON
Middle Name:S
Last Name:LONNER
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 1:820 SECOND AVENUE
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5705
Mailing Address - Country:US
Mailing Address - Phone:212-986-0140
Mailing Address - Fax:212-986-0160
Practice Address - Street 1:820 2ND AVE
Practice Address - Street 2:SUITE 7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4504
Practice Address - Country:US
Practice Address - Phone:212-986-0140
Practice Address - Fax:212-986-0160
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134067705OtherTAX ID#
NY244281Medicare ID - Type Unspecified
NYG22381Medicare UPIN