Provider Demographics
NPI:1215001813
Name:DITZIG, RONALD SEBASTIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SEBASTIAN
Last Name:DITZIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 2 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405
Mailing Address - Country:US
Mailing Address - Phone:973-492-0988
Mailing Address - Fax:973-492-0988
Practice Address - Street 1:210 2 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405
Practice Address - Country:US
Practice Address - Phone:973-492-0988
Practice Address - Fax:973-492-0988
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001289213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1834401Medicaid
NJ1834401Medicaid
454645Medicare ID - Type Unspecified