Provider Demographics
NPI:1679533400
Name:KAFILUDDI, RONNY (MD, PHD)
Entity type:Individual
Prefix:
First Name:RONNY
Middle Name:
Last Name:KAFILUDDI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:
Practice Address - Street 1:711 TROY SCHENECTADY RD STE 202
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2461
Practice Address - Country:US
Practice Address - Phone:518-782-3938
Practice Address - Fax:518-782-3995
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256491208VP0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
39609OtherBCBS IA
IA1185454Medicaid
G62406Medicare UPIN
IAI15813Medicare PIN