Provider Demographics
NPI:1194897389
Name:RONAN, MICHAEL EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:RONAN
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 1:860 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4063
Mailing Address - Country:US
Mailing Address - Phone:516-868-6100
Mailing Address - Fax:516-546-8621
Practice Address - Street 1:860 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4063
Practice Address - Country:US
Practice Address - Phone:516-868-6100
Practice Address - Fax:516-546-8621
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219834208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY586201Medicare ID - Type Unspecified