Healthcare Provider Details

I. General information

NPI: 1477027662
Provider Name (Legal Business Name): RONI SHOUVAL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

17 SDEROT HAHASKALA ST. ENTRANCE A, APARTMENT 72
TEL AVIV TEL AVIV
6789036
IL

V. Phone/Fax

Practice location:
  • Phone: 212-639-5809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: