MEDICARE: RON ISRAELI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	187948	NY

General Provider Information

NPI Number	:	1396777025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RON ISRAELI MD

Provider Business Mailing Address
First Line	:	833 NORTHERN BLVD
Second Line	:	SUITE 160
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5322
Country	:	US
Telephone Number	:	516-498-8400
Fax Number	:	516-498-8404

Provider Business Practice Location Address
First Line	:	833 NORTHERN BLVD
Second Line	:	SUITE 160
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5322
Country	:	US
Telephone Number	:	516-498-8400
Fax Number	:	516-498-8404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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