MEDICARE: DR. RON GANIK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	037254	NY

General Provider Information

NPI Number	:	1063417061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON GANIK DDS

Provider Business Mailing Address
First Line	:	30 E 40TH ST
Second Line	:	SUITE 506
City	:	NEW YORK
State	:	NY
Zip	:	10016-1201
Country	:	US
Telephone Number	:	212-685-8200
Fax Number	:	212-685-8207

Provider Business Practice Location Address
First Line	:	30 EAST 40TH STREET
Second Line	:	RM 506
City	:	NEW YORK
State	:	NY
Zip	:	10016-1216
Country	:	US
Telephone Number	:	212-685-8200
Fax Number	:	212-685-8207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/06/2011

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