Healthcare Provider Details

I. General information

NPI: 1053729707
Provider Name (Legal Business Name): CORA EMILY WILSON RONSON MS ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 MT HOPE RD
MIDDLETOWN NY
10940-7135
US

IV. Provider business mailing address

6 BARCLAY ST
PORT JERVIS NY
12771-2301
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-2292
  • Fax: 845-342-2054
Mailing address:
  • Phone: 845-858-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number612111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: