Provider Demographics
NPI:1760595888
Name:RIGOLOSI, RONALD A (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:RIGOLOSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 TEANECK ROAD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0000
Mailing Address - Country:US
Mailing Address - Phone:201-833-3000
Mailing Address - Fax:201-227-6207
Practice Address - Street 1:4 HUNTER STREET
Practice Address - Street 2:2A
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644
Practice Address - Country:US
Practice Address - Phone:973-772-8585
Practice Address - Fax:973-772-8586
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03273300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ685257OtherMEDICARE GROUP PIN
NJC51660Medicare UPIN
NJ432177Medicare PIN