Provider Demographics
NPI:1235135229
Name:LIGRESTI, ROSARIO J (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:J
Last Name:LIGRESTI
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 1:20 PROSPECT AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:515-996-3091
Mailing Address - Fax:551-996-5727
Practice Address - Street 1:20 PROSPECT AVE STE 615
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:515-996-3091
Practice Address - Fax:551-996-5727
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ7877600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090884BAAMedicare ID - Type Unspecified
G29854Medicare UPIN