Provider Demographics
NPI:1336252816
Name:DAILEY, RON (MD)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:
Last Name:DAILEY
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 1:196A FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2116
Mailing Address - Country:US
Mailing Address - Phone:718-789-5900
Mailing Address - Fax:718-789-7440
Practice Address - Street 1:196A FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2116
Practice Address - Country:US
Practice Address - Phone:718-789-5900
Practice Address - Fax:718-789-7440
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549788Medicaid
NYF88034Medicare UPIN
NY01549788Medicaid