Healthcare Provider Details

I. General information

NPI: 1174529812
Provider Name (Legal Business Name): RONALD O. ROVETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 HOFSTRA DR
PLAINVIEW NY
11803-1814
US

IV. Provider business mailing address

43 HOFSTRA DR
PLAINVIEW NY
11803-1814
US

V. Phone/Fax

Practice location:
  • Phone: 516-692-8455
  • Fax: 516-692-8455
Mailing address:
  • Phone: 516-692-8455
  • Fax: 516-692-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number169771
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier01240922
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: