Provider Demographics
NPI:1285790600
Name:BAGNER, RONALD JAY (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAY
Last Name:BAGNER
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 1:8 AUER CT STE B
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5846
Mailing Address - Country:US
Mailing Address - Phone:732-390-0073
Mailing Address - Fax:732-390-5984
Practice Address - Street 1:8 AUER CT STE B
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5846
Practice Address - Country:US
Practice Address - Phone:732-390-0073
Practice Address - Fax:732-390-5984
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03763600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0893307Medicaid
NJ0893307Medicaid
NJBA75978Medicare UPIN