=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639455355
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. RAMON VALDERRAMA M.D., PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2011
-----------------------------------------------------
Last Update Date | 10/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 E 60TH ST SUITE 901
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-319-1929
-----------------------------------------------------
Fax | 212-223-3176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 E 60TH ST SUITE 901
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-319-1929
-----------------------------------------------------
Fax | 212-223-3176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RAMON VALDERRAMA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-319-1929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 144213
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------