Healthcare Provider Details

I. General information

NPI: 1134148398
Provider Name (Legal Business Name): ORANGE MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CENTRAL AVE SUITE 106
EAST ORANGE NJ
07018-2835
US

IV. Provider business mailing address

310 CENTRAL AVE SUITE 106
EAST ORANGE NJ
07018-2835
US

V. Phone/Fax

Practice location:
  • Phone: 973-674-4542
  • Fax: 973-674-3901
Mailing address:
  • Phone: 973-674-4542
  • Fax: 973-674-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04159700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA04511900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA04457800
License Number StateNJ

VIII. Authorized Official

Name: DR. RAMESH M KANIA
Title or Position: PRIMARY CARE PHYSICIAN
Credential: M.D
Phone: 12014077732