Ralph Samuel Dagostino, MD
Individual provider Active NPI Internal Medicine Physician · Harrison, NJ
NPI 1790798437 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1790798437
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 031348 (NJ)
- Practice address
- 450 Bergen St
Harrison, NJ 07029 - Phone
- (973) 484-6900
- Fax
- (973) 484-0029
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050215000647 | NJ | Practitioner - Family Practice | 8628020922 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031348 | NJ | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Care Associates of West Hudson | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 031348 | NJ | Yes |
Addresses
Primary practice location
450 Bergen St
Harrison, NJ 07029
Mailing address
450 Bergen St
Harrison, NJ 07029
Phone (973) 484-6900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D01953100 | Other | NJ | CPS |
Other providers in Harrison, NJ
- Berta Carmo
- Artur M Carvalho
- Lillian Chomiszak
- Indigo M Cinberg
- Elizabeth K Conroy
- Melanie Daniel
- Dental Care Associates of Harrison
- Developmental Disabilities Association of NJ Inc.
- Down to Earth Therapy LLC
- Dr. Nasir General Dentistry
All providers in Harrison, NJ · Internal Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.