Provider Demographics
NPI:1508836339
Name:FERRONI, BRYAN R (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
Last Name:FERRONI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100A KINGS WAY W
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2235
Mailing Address - Country:US
Mailing Address - Phone:856-218-8080
Mailing Address - Fax:856-218-8070
Practice Address - Street 1:100A KINGS WAY W
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2235
Practice Address - Country:US
Practice Address - Phone:856-218-8080
Practice Address - Fax:856-218-8070
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB65174207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8318905Medicaid
NJ035756Medicare ID - Type Unspecified
NJ8318905Medicaid