Provider Demographics
NPI:1699736561
Name:CHASE, RONALD MOORE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MOORE
Last Name:CHASE
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 1:263 7TH AVE
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7247
Mailing Address - Country:US
Mailing Address - Phone:718-246-8700
Mailing Address - Fax:718-246-8701
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:SUITE 2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7247
Practice Address - Country:US
Practice Address - Phone:718-246-8700
Practice Address - Fax:718-246-8701
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200980-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06132403Medicaid
NY06132403Medicaid
NY63G41Medicare ID - Type Unspecified