Provider Demographics
NPI:1447366455
Name:DAVIDOFF, RONALD JAY (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAY
Last Name:DAVIDOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BURNETT ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-3312
Mailing Address - Country:US
Mailing Address - Phone:413-536-3520
Mailing Address - Fax:860-253-5030
Practice Address - Street 1:153 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4592
Practice Address - Country:US
Practice Address - Phone:860-253-5020
Practice Address - Fax:860-253-5030
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0345862084P0800X, 2084P0804X
MA528052084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0023796OtherNEIGHBORHOOD HEALTH PLAN#
MA6178537OtherMASS HEALTH NUMBER
MA6178537OtherMASS HEALTH NUMBER
CTA57091Medicare UPIN