Healthcare Provider Details

I. General information

NPI: 1235449331
Provider Name (Legal Business Name): RONNIE ORGAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 PLEASANTVALE RD
TIVOLI NY
12583-5216
US

IV. Provider business mailing address

625 PLEASANTVALE RD
TIVOLI NY
12583-5216
US

V. Phone/Fax

Practice location:
  • Phone: 845-790-3356
  • Fax:
Mailing address:
  • Phone: 845-790-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number22602304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: