Provider Demographics
NPI:1447261060
Name:LAVINE, RONALD (DC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:LAVINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 BROADWAY STE 1200
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8106
Mailing Address - Country:US
Mailing Address - Phone:212-400-9663
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 1200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8106
Practice Address - Country:US
Practice Address - Phone:212-400-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00432600111N00000X
NYC02664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX16371Medicare PIN