Provider Demographics
NPI:1861522245
Name:TADDEO, RONALD J (MD,, PC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:TADDEO
Suffix:
Gender:M
Credentials:MD,, PC
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Mailing Address - Street 1:4 PHYLLIS DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2900
Mailing Address - Country:US
Mailing Address - Phone:631-447-7560
Mailing Address - Fax:631-447-7561
Practice Address - Street 1:4 PHYLLIS DR
Practice Address - Street 2:SUITE H
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2900
Practice Address - Country:US
Practice Address - Phone:631-447-7560
Practice Address - Fax:631-447-7561
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1232932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123293OtherHIP
NY222095432OtherUBH
NY095041OtherVALUE OPTIONS EMPIRE
NY0071438OtherVALUE OPTIONS GOVERNMENT
NY222095432OtherCIGNA
NY66F592OtherEMPIRE
NYP563956OtherOXFORD
NY3105845OtherGHI BMP
NY222095432OtherAETNA
NY222095432OtherCIGNA