Provider Demographics
NPI:1598925380
Name:SISON, EDWIN RYAN RACELA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN RYAN
Middle Name:RACELA
Last Name:SISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:125 PATERSON STREET
Practice Address - Street 2:SUITE 3100
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7827
Practice Address - Fax:732-235-6131
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA232550207L00000X
NJ25MA08958900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0273155Medicaid
NJ0273155Medicaid
NJ227256CDYMedicare PIN
NJ227256A01Medicare PIN