Provider Demographics
NPI:1881674612
Name:CSILLAG, RONALD A (DC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:A
Last Name:CSILLAG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34-38 BELL BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:718-352-4500
Mailing Address - Fax:718-352-4502
Practice Address - Street 1:34-38 BELL BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361
Practice Address - Country:US
Practice Address - Phone:718-352-4500
Practice Address - Fax:718-352-4502
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002633-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1I 01721177 9Medicaid
NY38629Medicare ID - Type Unspecified
NYX48811Medicare UPIN