Healthcare Provider Details

I. General information

NPI: 1962405340
Provider Name (Legal Business Name): RONALD SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 OVERLOOK AVE
HACKENSACK NJ
07601-2206
US

IV. Provider business mailing address

150 OVERLOOK AVE
HACKENSACK NJ
07601-2206
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-4100
  • Fax: 201-342-6250
Mailing address:
  • Phone: 201-342-4100
  • Fax: 201-342-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06975500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2610597
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA HMO ID #
# 2
Identifier8172307
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 3
IdentifierP2531090
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD ID #
# 4
Identifier487F91
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerBC/BS OF NY ID #
# 5
Identifier5220551
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA PPO ID #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: