Provider Demographics
NPI:1417070202
Name:RALPH C LANCIANO JR DO PA
Entity Type:Organization
Organization Name:RALPH C LANCIANO JR DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANCIANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:856-665-5533
Mailing Address - Street 1:7703 MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109
Mailing Address - Country:US
Mailing Address - Phone:856-665-5533
Mailing Address - Fax:856-665-5055
Practice Address - Street 1:7703 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3374
Practice Address - Country:US
Practice Address - Phone:856-665-5533
Practice Address - Fax:856-665-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MBO2148900207W00000X
NJ25MA07415200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDN3730Medicare PIN
NJ767228Medicare PIN
NJC52423Medicare UPIN