Healthcare Provider Details

I. General information

NPI: 1740271998
Provider Name (Legal Business Name): RONALD J POBLETE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 MARKET ST SUITE 2
SADDLE BROOK NJ
07663-6048
US

IV. Provider business mailing address

502 HAMBURG TPKE SUITE 108
WAYNE NJ
07470-8431
US

V. Phone/Fax

Practice location:
  • Phone: 201-587-9204
  • Fax: 201-587-0623
Mailing address:
  • Phone: 973-942-5224
  • Fax: 973-942-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05479500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA05479500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: