Ronald George Intelisano, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MB05610900 Issued in NJ

Practice address

1504 Blackwood Clementon Rd
Blackwood, NJ 08012-4625

Phone

(856) 228-0144

Fax

(856) 232-0320

NPI assigned

Nov 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235200775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 BLACKWOOD CLEMENTON RD",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080124625",
            "telephone_number": "856-228-0144",
            "fax_number": "856-232-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 BLACKWOOD CLEMENTON RD",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080124625",
            "telephone_number": "856-228-0144",
            "fax_number": "856-232-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INTELISANO",
        "first_name": "RONALD",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MB05610900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Horan
• Audrey Jane Iacobucci, MD
• Robert Iannace Jr., LAC, NCC
• Joseph Michael Iannelli III, DC
• Infectious Disease Clinic
• Sneh Jain, MD
• Cheryl Jalloh, NP
• Jerry'S Mobility
• Jillian Kalitz
• Tonya Christine Jones

• Internal Medicine Physician in Blackwood, NJ
• Providers in Blackwood, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.