1588762454 NPI number — BERNARD J RONIS MD & EMIL P LIEBMAN PTR

Table of content: (NPI 1588762454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588762454 NPI number — BERNARD J RONIS MD & EMIL P LIEBMAN PTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNARD J RONIS MD & EMIL P LIEBMAN PTR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588762454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 822336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-2336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-902-6092
Provider Business Mailing Address Fax Number:
610-902-6081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
HADDONFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08033-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-428-9314
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIEBMAN
Authorized Official First Name:
EMIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
856-428-9314

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0802631000 . This is a "IBC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6597700 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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