Provider Demographics
NPI:1356543185
Name:DOMERACKI, RONALD STEVEN (BS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:STEVEN
Last Name:DOMERACKI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 WEIDNER CT
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-6002
Mailing Address - Country:US
Mailing Address - Phone:215-536-1103
Mailing Address - Fax:
Practice Address - Street 1:3075 RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403
Practice Address - Country:US
Practice Address - Phone:610-265-4700
Practice Address - Fax:610-265-3439
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006046L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist