Provider Demographics
NPI:1396777025
Name:ISRAELI, RON (MD)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:ISRAELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:833 NORTHERN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5322
Mailing Address - Country:US
Mailing Address - Phone:516-498-8400
Mailing Address - Fax:516-498-8404
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5322
Practice Address - Country:US
Practice Address - Phone:516-498-8400
Practice Address - Fax:516-498-8404
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY187948208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45750Medicare UPIN
NY28L761Medicare ID - Type Unspecified