Healthcare Provider Details

I. General information

NPI: 1992769236
Provider Name (Legal Business Name): RONALD RICHARD BARATTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 N WELLWOOD AVE SUITE 4
LINDENHURST NY
11757-1677
US

IV. Provider business mailing address

672 N WELLWOOD AVE SUITE 4
LINDENHURST NY
11757-1677
US

V. Phone/Fax

Practice location:
  • Phone: 631-957-2200
  • Fax: 631-957-4619
Mailing address:
  • Phone: 631-957-2200
  • Fax: 631-957-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number93113
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: