=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760790356
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD EMERSON, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2010
-----------------------------------------------------
Last Update Date | 05/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 E 70TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-774-2004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 E 70TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | RONALD EMERSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-774-2004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 146156
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------