Basic Information
| Provider Information | |||||||||
| NPI: | 1396769014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARO | ||||||||
| FirstName: | RONALD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 PINE ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ROCKAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078663139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736277922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 POCONO RD | ||||||||
| Address2: | |||||||||
| City: | DENVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078342954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736256000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 25MA06704700 | NJ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 8119601 | 05 | NJ | MEDICAID |