Provider Demographics
NPI:1134148398
Name:ORANGE MEDICAL GROUP PA
Entity type:Organization
Organization Name:ORANGE MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1201-407-7732
Mailing Address - Street 1:310 CENTRAL AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-674-4542
Mailing Address - Fax:973-674-3901
Practice Address - Street 1:310 CENTRAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2835
Practice Address - Country:US
Practice Address - Phone:973-674-4542
Practice Address - Fax:973-674-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04511900207RC0000X
NJ25MA04159700207R00000X
NJ25MA04457800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5623308Medicaid
NJ706230Medicare ID - Type Unspecified