Provider Demographics
NPI:1528235157
Name:RONEY, JOHN J (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:RONEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVENUE
Mailing Address - Street 2:THE CENTER FOR ADVANCED PEDIATRICS
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-229-2000
Mailing Address - Fax:203-840-9055
Practice Address - Street 1:761 MAIN AVENUE
Practice Address - Street 2:THE CENTER FOR ADVANCED PEDIATRICS
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-229-2000
Practice Address - Fax:203-840-9055
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000489363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical