Provider Demographics
NPI:1750532503
Name:KONIGSBERG, RALEE (MD)
Entity type:Individual
Prefix:
First Name:RALEE
Middle Name:
Last Name:KONIGSBERG
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 1:277 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1476
Mailing Address - Country:US
Mailing Address - Phone:814-574-0729
Mailing Address - Fax:
Practice Address - Street 1:277 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1476
Practice Address - Country:US
Practice Address - Phone:732-235-6700
Practice Address - Fax:732-235-6723
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09154200207Q00000X
DEC1-0009776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine