Healthcare Provider Details

I. General information

NPI: 1770538258
Provider Name (Legal Business Name): RONALD P. PELLETIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLUM ST FL 7
NEW BRUNSWICK NJ
08901-2066
US

IV. Provider business mailing address

10 PLUM ST FL 7
NEW BRUNSWICK NJ
08901-2066
US

V. Phone/Fax

Practice location:
  • Phone: 732-253-3360
  • Fax: 732-253-3476
Mailing address:
  • Phone: 732-253-3360
  • Fax: 732-253-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA10296500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number35058355
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number25MA10296500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: