Provider Demographics
NPI:1821061581
Name:RAMETTA, CONCETTO S (MD)
Entity Type:Individual
Prefix:DR
First Name:CONCETTO
Middle Name:S
Last Name:RAMETTA
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 1:22 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4806
Mailing Address - Country:US
Mailing Address - Phone:845-343-0659
Mailing Address - Fax:845-343-8024
Practice Address - Street 1:22 GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4806
Practice Address - Country:US
Practice Address - Phone:845-343-0659
Practice Address - Fax:845-343-8024
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12248Medicare UPIN
NY287781Medicare ID - Type Unspecified