Individual
DR. RONALD GENE NATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1672 WESTERN AVE, ALBANY, NY 12203-4218
(518) 422-1850
Mailing address
1672 WESTERN AVE, ALBANY, NY 12203-4218
(518) 422-1850
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
009408
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000490288004
BLUE SHIELD
NY
05
—
01382769
—
NY
01
—
058011
CDPHP PROVIDER NUMBER
NY
01
—
41300
MVP PROVIDER NUMBER
NY
01
—
6894417
GHI PROVIDER NUMBER
NY
Enumeration date
12/04/2006
Last updated
07/09/2007
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