Provider Demographics
NPI:1659418242
Name:LEMONGELLO, RALPH M (DC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:M
Last Name:LEMONGELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 HAMBURG TPKE
Mailing Address - Street 2:STE 303
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4032
Mailing Address - Country:US
Mailing Address - Phone:973-696-0032
Mailing Address - Fax:973-939-8488
Practice Address - Street 1:1501 HAMBURG TPKE
Practice Address - Street 2:STE 303
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4032
Practice Address - Country:US
Practice Address - Phone:973-696-0032
Practice Address - Fax:973-939-8488
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00245400111N00000X
NYX009679-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0105012000OtherAMERIHEALTH
NJP676747OtherOXFORD HEALTH PLANS
NJ454632Medicare ID - Type Unspecified