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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | SHAW, RICKY AKA ROSS, DOUGLAS | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| Status | not available | [sources] | |||
| Address | 123 N. 19TH STREET, EAST ORANGE, NJ 07017 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers disqualified from participating in New Jersey State's Medicaid program.
United States · OIFP
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| Address | ||
|---|---|---|
| Full address | Country | |
| 123 N. 19TH STREET, EAST ORANGE, NJ 07017 | United States | |