Basic Information
| Provider Information | |||||||||
| NPI: | 1649208125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMAIO | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | AMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 205 BROWERTOWN RD | ||||||||
| Address2: | STE 206 | ||||||||
| City: | WEST PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738370230 | ||||||||
| FaxNumber: | 9738370234 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 BROWERTOWN RD | ||||||||
| Address2: | STE 206 | ||||||||
| City: | WEST PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738370230 | ||||||||
| FaxNumber: | 9738370234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 01/09/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MA03523800 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 4229686 | 01 | NJ | AETNA PPO | OTHER | 1232Z1 | 01 | NJ | BC BS OF NY SUITE 206 W PATERSON | OTHER | 1651102 | 05 | NJ | MEDICAID | 398169 | 01 | NJ | WELLCARE | OTHER | 0091820000 | 01 | NJ | AMERIHEALTH | OTHER | 0554215 | 01 | NJ | GHI PPO | OTHER | P3928339 | 01 | NJ | OXFORD | OTHER | 3K8632 | 01 | NJ | HEALTHNET | OTHER | 1945333 | 01 | NJ | AETNA HMO | OTHER | 1232Z2 | 01 | NJ | BC/BS OF NY SUITE 102 W PATERSON | OTHER |