Provider Demographics
NPI:1588762454
Name:BERNARD J RONIS MD & EMIL P LIEBMAN PTR
Entity type:Organization
Organization Name:BERNARD J RONIS MD & EMIL P LIEBMAN PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-428-9314
Mailing Address - Street 1:PO BOX 822336
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2336
Mailing Address - Country:US
Mailing Address - Phone:610-902-6092
Mailing Address - Fax:610-902-6081
Practice Address - Street 1:30 WASHINGTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-3341
Practice Address - Country:US
Practice Address - Phone:856-428-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0802631000OtherIBC
NJ6597700Medicaid
NJCA7162Medicare PIN
NJ778381Medicare PIN