Provider Demographics
NPI:1760440986
Name:RAMOS, LEONOR VIVAS (MD)
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:VIVAS
Last Name:RAMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MSGR WOJTYCHA DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4891
Mailing Address - Country:US
Mailing Address - Phone:201-451-4308
Mailing Address - Fax:
Practice Address - Street 1:324 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-459-8888
Practice Address - Fax:201-459-8872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8044309Medicaid
NJH04761Medicare UPIN
NJ31799Medicare ID - Type Unspecified