Provider Demographics
NPI:1265489207
Name:GO, ERNESTO B (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:B
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2384 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-6673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 4, SUITE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8467
Practice Address - Country:US
Practice Address - Phone:856-794-8664
Practice Address - Fax:856-794-2671
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA029071002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ300127248OtherRAILROAD MEDICARE
NJ1156712OtherHORIZON NJ HEALTH
NJ812429OtherMEDICARE OF NJ
NJ0073104000OtherAMERIHEALTH
NJ2153505Medicaid
NJ300127248OtherRAILROAD MEDICARE