Provider Demographics
NPI:1386683894
Name:MACK, RONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:MACK
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 1:53 FELLSWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX FELLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07021
Mailing Address - Country:US
Mailing Address - Phone:973-228-4220
Mailing Address - Fax:973-621-8417
Practice Address - Street 1:175 HIGH STREET
Practice Address - Street 2:NEWTON HOSPITAL EA
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-579-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03013300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine