Provider Demographics
NPI:1124122866
Name:DALY, RONALD ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:ALEXANDER
Last Name:DALY
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 1:96-98 MILLBURN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:973-378-9226
Mailing Address - Fax:973-378-3969
Practice Address - Street 1:96-98 MILLBURN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-378-9226
Practice Address - Fax:973-378-3969
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03989200207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
90000283200OtherAMERICHOICE
1037272OtherHORIZON NJ HEALT MEDICAID
223254028-001OtherST BARNABAS
P-1268565OtherOXFORD W/ AUTHORIZATION
11523200OtherUS DEPT OF LABOR AUTHORIZ
30337OtherAMERIGROUP
NJ3423107Medicaid
420518OtherAETNA US HEALTH CARE
223254028-001OtherST BARNABAS
90000283200OtherAMERICHOICE