Provider Demographics
NPI:1487735882
Name:RATNER, ROMAN (PA)
Entity type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:
Last Name:RATNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WEST 8TH STREET,
Mailing Address - Street 2:APT. 19G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224
Mailing Address - Country:US
Mailing Address - Phone:718-373-0458
Mailing Address - Fax:
Practice Address - Street 1:3101 OCEAN PKWY APT 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8403
Practice Address - Country:US
Practice Address - Phone:718-946-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01743888Medicaid
NY01743888Medicaid