Provider Demographics
NPI:1700066206
Name:LOUIS J RONDINELLA, MD,PA
Entity Type:Organization
Organization Name:LOUIS J RONDINELLA, MD,PA
Other - Org Name:LOUIS J RONDINELLA, MD,PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RONDINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-601-9055
Mailing Address - Street 1:647 SHORE RD
Mailing Address - Street 2:PO BOX 608
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2449
Mailing Address - Country:US
Mailing Address - Phone:609-601-9055
Mailing Address - Fax:609-601-0276
Practice Address - Street 1:647 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2449
Practice Address - Country:US
Practice Address - Phone:609-601-9055
Practice Address - Fax:609-601-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06403100207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6697309Medicaid
NJ6697309Medicaid
NJG30499Medicare UPIN