Provider Demographics
NPI:1225075096
Name:SCHIAVONE, RONALD L
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:SCHIAVONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:222 GIBBSBORO RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4132
Practice Address - Country:US
Practice Address - Phone:856-784-4999
Practice Address - Fax:856-784-0258
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB34991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069607000OtherHMO INDEPEN BLUE CROSS
NJ2209101Medicaid
NJ000000326OtherPPO INDEPEN BLUE CROSS
NJE70386Medicare UPIN
NJ000326AAAMedicare PIN