Provider Demographics
NPI:1427267517
Name:RONALD E BURBELLA MD PC
Entity type:Organization
Organization Name:RONALD E BURBELLA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-530-9100
Mailing Address - Street 1:2500 BRUNSWICK PIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4134
Mailing Address - Country:US
Mailing Address - Phone:609-530-9100
Mailing Address - Fax:609-530-0743
Practice Address - Street 1:2500 BRUNSWICK PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4134
Practice Address - Country:US
Practice Address - Phone:609-530-9100
Practice Address - Fax:609-530-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03214300207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1082302Medicaid
NJCF1909OtherRAIL ROAD MEDICARE
NJ1082302Medicaid