Provider Demographics
NPI:1235109976
Name:ABOODY, RONALD SOLOMON (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SOLOMON
Last Name:ABOODY
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 1:935 ALLWOOD RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1988
Mailing Address - Country:US
Mailing Address - Phone:973-365-2750
Mailing Address - Fax:973-365-9980
Practice Address - Street 1:350 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:973-365-4300
Practice Address - Fax:973-365-9980
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA6086700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6795709Medicaid
NJ6795709Medicaid
NJ787166Medicare ID - Type Unspecified