Healthcare Provider Details

I. General information

NPI: 1063417061
Provider Name (Legal Business Name): RON GANIK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EAST 40TH STREET RM 506
NEW YORK NY
10016-1216
US

IV. Provider business mailing address

30 E 40TH ST SUITE 506
NEW YORK NY
10016-1201
US

V. Phone/Fax

Practice location:
  • Phone: 212-685-8200
  • Fax: 212-685-8207
Mailing address:
  • Phone: 212-685-8200
  • Fax: 212-685-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number037254
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: