Provider Demographics
NPI:1477611465
Name:NATHAN, RONALD GENE (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GENE
Last Name:NATHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4218
Mailing Address - Country:US
Mailing Address - Phone:518-422-1850
Mailing Address - Fax:
Practice Address - Street 1:1672 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4218
Practice Address - Country:US
Practice Address - Phone:518-422-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6894417OtherGHI PROVIDER NUMBER
NY058011OtherCDPHP PROVIDER NUMBER
NY41300OtherMVP PROVIDER NUMBER
NY000490288004OtherBLUE SHIELD
NY01382769Medicaid
NY000490288004OtherBLUE SHIELD
NYCC8480Medicare ID - Type UnspecifiedMEDICARE NUMBER