Provider Demographics
NPI:1255322376
Name:PALLANT, RONALD D (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:D
Last Name:PALLANT
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 1:155 MORRIS AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1225
Mailing Address - Country:US
Mailing Address - Phone:973-232-2300
Mailing Address - Fax:973-232-2301
Practice Address - Street 1:155 MORRIS AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1225
Practice Address - Country:US
Practice Address - Phone:973-232-2300
Practice Address - Fax:973-232-2311
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ30097208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1992601Medicaid
C58567Medicare UPIN
NJ1992601Medicaid