Provider Demographics
NPI:1952721193
Name:COMISSIONG, RICARDO
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:COMISSIONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9728 57TH AVENUE
Mailing Address - Street 2:APT 7G
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3523
Mailing Address - Country:US
Mailing Address - Phone:347-423-4381
Mailing Address - Fax:
Practice Address - Street 1:9728 57TH AVE
Practice Address - Street 2:APT 7G
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3545
Practice Address - Country:US
Practice Address - Phone:347-423-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherNEW YORK STATE DEPARTMENT OF EDUCATION