Provider Demographics
NPI:1801853965
Name:FALCON, RONALD HARLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HARLAN
Last Name:FALCON
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 1:604 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2505
Mailing Address - Country:US
Mailing Address - Phone:516-432-0011
Mailing Address - Fax:516-889-5681
Practice Address - Street 1:604 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2505
Practice Address - Country:US
Practice Address - Phone:516-432-0011
Practice Address - Fax:516-889-5681
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167970-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
13452OtherGHI
8226207006OtherCIGNA
18988OtherMASTERCARE
2C8726OtherHEALTH NET
NY01453507Medicaid
0458774OtherAETNA/USHC/PRUCARE
13364OtherUNITED HEALTHCARE
36E771OtherBCBS
AS172OtherOXFORD
070008110OtherPALMETTO GBA/RR MEDICARE
23718OtherVYTRA
8226207006OtherCIGNA
NY36E771Medicare ID - Type Unspecified