Provider Demographics
NPI:1194170126
Name:RON S ISRAELI MD PC
Entity type:Organization
Organization Name:RON S ISRAELI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:ISRAELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-251-2055
Mailing Address - Street 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-251-2055
Mailing Address - Fax:
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-251-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07388600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG45741Medicare UPIN