Provider Demographics
NPI:1386409050
Name:BANCUD, RONALD NARAG
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:NARAG
Last Name:BANCUD
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 1:191 CORBIN RDG
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-9484
Mailing Address - Country:US
Mailing Address - Phone:718-313-7706
Mailing Address - Fax:
Practice Address - Street 1:655 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-3369
Practice Address - Country:US
Practice Address - Phone:860-782-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist