MEDICARE: MR. RONALDO T FARAON RN

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	163W00000X	Registered Nurse	650243-1	NY

General Provider Information

NPI Number	:	1518204379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALDO T FARAON RN

Provider Business Mailing Address
First Line	:	95 SEDGWICK AVE
Second Line	:	5E
City	:	YONKERS
State	:	NY
Zip	:	10705-2604
Country	:	US
Telephone Number	:	914-207-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 W 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-2925
Country	:	US
Telephone Number	:	212-376-1810
Fax Number	:

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

Provider Enumeration Date	:	01/13/2013
Last Update Date	:	01/13/2013

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