Basic Information
| Provider Information | |||||||||
| NPI: | 1760595888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIGOLOSI | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 TEANECK ROAD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076660000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018333000 | ||||||||
| FaxNumber: | 2012276207 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 HUNTER STREET | ||||||||
| Address2: | 2A | ||||||||
| City: | LODI | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737728585 | ||||||||
| FaxNumber: | 9737728586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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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 | 207R00000X | 25MA03273300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 685257 | 01 | NJ | MEDICARE GROUP PIN | OTHER |