Provider Demographics
NPI:1922104215
Name:VALDERRAMA, RAMON (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:VALDERRAMA
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 60TH ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1008
Mailing Address - Country:US
Mailing Address - Phone:212-319-1929
Mailing Address - Fax:212-223-3176
Practice Address - Street 1:30 E 60TH ST
Practice Address - Street 2:SUITE 901
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1008
Practice Address - Country:US
Practice Address - Phone:212-319-1929
Practice Address - Fax:212-223-3176
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1442132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00626384Medicaid
NY144213OtherNY STATE LIC. #
B16243Medicare UPIN
54A931Medicare ID - Type UnspecifiedPROVIDER ID