Provider Demographics
NPI:1013980994
Name:IANNACONE, RONALD F (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:F
Last Name:IANNACONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6910 AVENUE U
Mailing Address - Street 2:SUITE LA
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6129
Mailing Address - Country:US
Mailing Address - Phone:718-968-8080
Mailing Address - Fax:718-968-8088
Practice Address - Street 1:6910 AVENUE U
Practice Address - Street 2:SUITE LA
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6129
Practice Address - Country:US
Practice Address - Phone:718-968-8080
Practice Address - Fax:718-968-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004104213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01020057Medicaid
NY35514Medicare ID - Type UnspecifiedMEDICARE # IN QUEENS(GHI)
NY6348130001Medicare NSC
NYP43603Medicare ID - Type UnspecifiedMEDICARE# IN BKLYN(BCBS)
NYT31877Medicare UPIN