Provider Demographics
NPI:1205915253
Name:KAITZ, RONALD I (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:I
Last Name:KAITZ
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 1:250 E HARTSDALE AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:914-725-5959
Mailing Address - Fax:914-725-7363
Practice Address - Street 1:250 E HARTSDALE AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-725-5959
Practice Address - Fax:914-725-7363
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1392132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17387Medicare UPIN
NY64A341Medicare ID - Type Unspecified