Basic Information
| Provider Information | |||||||||
| NPI: | 1164591715 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MORTON | ||||||||
| FirstName: | RONALD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 GEORGE ST | ||||||||
| Address2: | UNIVERSITY MEDICAL GROUP 3RD FLOOR | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089012008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322358282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 PATERSON ST | ||||||||
| Address2: | CLINICAL ACADEMIC BUILDING - SUITE 4100 | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357776 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MA769940 | NJ | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0027570 | 05 | NJ | MEDICAID |