Provider Demographics
NPI:1033227459
Name:REGO, RAMON (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:REGO
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 1:65 WOODLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07926
Mailing Address - Country:US
Mailing Address - Phone:908-889-4911
Mailing Address - Fax:
Practice Address - Street 1:3322 ROUTE 22
Practice Address - Street 2:BLDG #1
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:908-704-0100
Practice Address - Fax:908-704-2237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05810600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046928Medicare ID - Type Unspecified
NJF33433Medicare UPIN