Healthcare Provider Details

I. General information

NPI: 1790739308
Provider Name (Legal Business Name): EWING MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 PENNINGTON RD
TRENTON NJ
08618-1301
US

IV. Provider business mailing address

1539 PENNINGTON RD
TRENTON NJ
08618-1301
US

V. Phone/Fax

Practice location:
  • Phone: 609-883-4124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB05671800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04829200
License Number StateNJ

VIII. Authorized Official

Name: EUGENE A RYFINSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 609-883-4124