Provider Demographics
NPI:1740271998
Name:POBLETE, RONALD J (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:POBLETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:502 HAMBURG TPKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8431
Mailing Address - Country:US
Mailing Address - Phone:973-942-5224
Mailing Address - Fax:973-942-7443
Practice Address - Street 1:289 MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6048
Practice Address - Country:US
Practice Address - Phone:201-587-9204
Practice Address - Fax:201-587-0623
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2013-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05479500207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4645405Medicaid
NJ4645405Medicaid
NJ122932Medicare PIN