MEDICARE: MR. RONALD WILLIAM DEMPSEY LPN

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	164W00000X	Licensed Practical Nurse	209905-1	NY

General Provider Information

NPI Number	:	1871971416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD WILLIAM DEMPSEY LPN

Provider Business Mailing Address
First Line	:	14728 HILLSIDE AVE
Second Line	:	2ND FLOOR
City	:	JAMAICA
State	:	NY
Zip	:	11435-3329
Country	:	US
Telephone Number	:	718-374-5949
Fax Number	:	646-374-3955

Provider Business Practice Location Address
First Line	:	14728 HILLSIDE AVE
Second Line	:	2ND FLOOR
City	:	JAMAICA
State	:	NY
Zip	:	11435-3329
Country	:	US
Telephone Number	:	718-374-5949
Fax Number	:	646-374-3955

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	05/15/2015

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