Provider Demographics
NPI:1386812659
Name:MOROCH, RONALD
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MOROCH
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 1:45 TIFFANY WAY
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1054
Mailing Address - Country:US
Mailing Address - Phone:631-265-7322
Mailing Address - Fax:
Practice Address - Street 1:2162 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3503
Practice Address - Country:US
Practice Address - Phone:631-444-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24430OtherRPH STATE LICENSE NUMBER