Provider Demographics
NPI:1386716389
Name:ZEVIN, RONALD A (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:ZEVIN
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 1:50 UNION AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3262
Mailing Address - Country:US
Mailing Address - Phone:973-372-8844
Mailing Address - Fax:973-372-6687
Practice Address - Street 1:50 UNION AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3262
Practice Address - Country:US
Practice Address - Phone:973-372-8844
Practice Address - Fax:973-372-6687
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02106400207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2695103Medicaid
NJ2695103Medicaid
458515UUQMedicare PIN