Provider Demographics
NPI:1366975971
Name:ROLAND L BELLUSCIO, MD LLC
Entity type:Organization
Organization Name:ROLAND L BELLUSCIO, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELLUSCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-268-8608
Mailing Address - Street 1:280 HIGHWAY 35
Mailing Address - Street 2:STE 101
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5900
Mailing Address - Country:US
Mailing Address - Phone:732-868-8608
Mailing Address - Fax:
Practice Address - Street 1:280 HIGHWAY 35
Practice Address - Street 2:STE 101
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5900
Practice Address - Country:US
Practice Address - Phone:732-268-8608
Practice Address - Fax:732-268-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty