Basic Information
| Provider Information | |||||||||
| NPI: | 1508987892 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAMOV | ||||||||
| FirstName: | RONNEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO, MS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5 PLAINSBORO RD STE 390 | ||||||||
| Address2: | |||||||||
| City: | PLAINSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085361916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094974371 | ||||||||
| FaxNumber: | 6094974379 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 PLAINSBORO RD STE 390 | ||||||||
| Address2: | |||||||||
| City: | PLAINSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085361916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094974371 | ||||||||
| FaxNumber: | 6094974379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 25MB08565700 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 2081P2900X | OS014717 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0203874 | 05 | NJ | MEDICAID | 1023367450001 | 05 | PA | MEDICAID |