Healthcare Provider Details

I. General information

NPI: 1245330117
Provider Name (Legal Business Name): JILL ROBIN RATNER D.O. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N RIGAUD RD
SPRING VALLEY NY
10977-2533
US

IV. Provider business mailing address

25 N RIGAUD RD
SPRING VALLEY NY
10977-2533
US

V. Phone/Fax

Practice location:
  • Phone: 917-445-3283
  • Fax:
Mailing address:
  • Phone: 917-445-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number227206-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number227206-1
License Number StateNY

VIII. Authorized Official

Name: DR. JILL R RATNER
Title or Position: OWNER PHYSICIAN
Credential: D.O.
Phone: 917-445-3283