Provider Demographics
NPI:1366594608
Name:RON BAKAL MD PC
Entity type:Organization
Organization Name:RON BAKAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-679-6464
Mailing Address - Street 1:461 PARK AVE SOUTH
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-679-6464
Mailing Address - Fax:212-679-6472
Practice Address - Street 1:461 PARK AVE S
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6822
Practice Address - Country:US
Practice Address - Phone:212-679-6464
Practice Address - Fax:212-679-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206016208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWR731Medicare PIN