Healthcare Provider Details

I. General information

NPI: 1356435200
Provider Name (Legal Business Name): RONALD QUIBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PERRINE RD SUITE 229
OLD BRIDGE NJ
08857-2842
US

IV. Provider business mailing address

200 PERRINE RD SUITE 229
OLD BRIDGE NJ
08857-2842
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-8800
  • Fax: 732-727-0955
Mailing address:
  • Phone: 732-727-8800
  • Fax: 732-727-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA05603900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier187169
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAMERIGROUP
# 2
Identifier5342690
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA PPO
# 3
Identifier60028867
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerHORIZON NJ HEALTH
# 4
IdentifierP3541006
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD
# 5
Identifier8B0331
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS
# 6
Identifier1552937
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA HMO
# 7
Identifier2836391000
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAMERIHEALTH
# 8
Identifier3K4574
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTHNET
# 9
Identifier91001743503
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAMERICHOICE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: