Healthcare Provider Details

I. General information

NPI: 1114085719
Provider Name (Legal Business Name): MR. JOHNNY RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 ENGLEWOOD RD
CLIFTON NJ
07012-2163
US

IV. Provider business mailing address

82 ENGLEWOOD RD
CLIFTON NJ
07012-2163
US

V. Phone/Fax

Practice location:
  • Phone: 973-357-8228
  • Fax: 973-357-4998
Mailing address:
  • Phone: 973-357-8228
  • Fax: 973-357-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number332BC3200X
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: