Provider Demographics
NPI:1588752786
Name:FEDERICO, RONALD JAY (DC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAY
Last Name:FEDERICO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 SHILOH PIKE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1485
Mailing Address - Country:US
Mailing Address - Phone:856-451-1116
Mailing Address - Fax:888-570-5045
Practice Address - Street 1:597 SHILOH PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1485
Practice Address - Country:US
Practice Address - Phone:856-451-1116
Practice Address - Fax:888-570-5045
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00482000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ655594Medicare ID - Type Unspecified
NJ10655882Medicare UPIN