Provider Demographics
NPI:1316315559
Name:SEVER, RONEN
Entity type:Individual
Prefix:
First Name:RONEN
Middle Name:
Last Name:SEVER
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 1:140 RIVERSIDE BLVD
Mailing Address - Street 2:APT 703
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0601
Mailing Address - Country:US
Mailing Address - Phone:646-755-1009
Mailing Address - Fax:
Practice Address - Street 1:140 RIVERSIDE BLVD
Practice Address - Street 2:APT 703
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-0601
Practice Address - Country:US
Practice Address - Phone:646-755-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP96757207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine