Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 25MA08099000 | NJ |
NPI | 1003828823 |
---|---|
Provider Name | Ellen A Ronnen |
First Address | East Brunswick, NJ 08816 |
Second Address | East Brunswick, NJ 08816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0122971 | (05) | NJ |
1790396281 | TITAN HEALTH GROUP NPI# (01) | NJ |
I63926 | (02) | NJ |