MEDICARE: DR. RICHARD WILLIAM RONDANINA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MA70896	NJ
2	208M00000X	Hospitalist Physician	25MA07089600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MA70896	OTHER	NJ	MEDICAL LICENSE

General Provider Information

NPI Number	:	1720064744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WILLIAM RONDANINA M.D

Provider Business Mailing Address
First Line	:	1925 PACIFIC AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-6713
Country	:	US
Telephone Number	:	609-345-4000
Fax Number	:	609-442-8002

Provider Business Practice Location Address
First Line	:	64 SPRINGFIELD AVE
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1027
Country	:	US
Telephone Number	:	201-288-0664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	05/14/2021

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