Provider Demographics
NPI:1831134865
Name:D'AGOSTINO, RONALD D (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:D'AGOSTINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:SUITE E 124
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-627-2121
Mailing Address - Fax:516-627-4922
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:SUITE E 124
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-627-2121
Practice Address - Fax:516-627-4922
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166861207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26K511Medicare ID - Type Unspecified
NYF19095Medicare UPIN