Provider Demographics
NPI:1740480243
Name:WISH, RON I (MD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:I
Last Name:WISH
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 1:112 HIGHMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1509
Mailing Address - Country:US
Mailing Address - Phone:845-358-4815
Mailing Address - Fax:
Practice Address - Street 1:112 HIGHMOUNT AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1509
Practice Address - Country:US
Practice Address - Phone:845-358-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine