Healthcare Provider Details

I. General information

NPI: 1073562872
Provider Name (Legal Business Name): RALPH DAUITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 NEW JERSEY AVE
ABSECON NJ
08201-2423
US

IV. Provider business mailing address

1690 WHISPERING WOODS WAY
VINELAND NJ
08361-8602
US

V. Phone/Fax

Practice location:
  • Phone: 856-466-3399
  • Fax:
Mailing address:
  • Phone: 856-466-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05144800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: