Provider Demographics
NPI:1326199514
Name:ONG, EDGARDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:A
Last Name:ONG
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 1:65 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1313
Mailing Address - Country:US
Mailing Address - Phone:973-401-1100
Mailing Address - Fax:973-401-1201
Practice Address - Street 1:117 SEBER RD
Practice Address - Street 2:UNIT 1B
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1722
Practice Address - Country:US
Practice Address - Phone:908-979-1302
Practice Address - Fax:973-401-1201
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03006500207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1259709Medicaid
NJ097317Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
NJ1259709Medicaid