Provider Demographics
NPI:1811918147
Name:RONALD E LATHER MDPC
Entity type:Organization
Organization Name:RONALD E LATHER MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOJDYLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-829-8240
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:5457 E SENECA ST
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476
Mailing Address - Country:US
Mailing Address - Phone:315-829-8240
Mailing Address - Fax:315-829-8242
Practice Address - Street 1:5457 E SENECA ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476
Practice Address - Country:US
Practice Address - Phone:315-829-8240
Practice Address - Fax:315-829-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098917207KA0200X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD6192Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
AA1664Medicare ID - Type UnspecifiedGROUP NUMBER
B81023Medicare UPIN